Provider Demographics
NPI:1275339145
Name:HERNDON, ALICIA NICOLE (SURGICAL TECH)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:NICOLE
Last Name:HERNDON
Suffix:
Gender:
Credentials:SURGICAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 MALONE CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-1119
Mailing Address - Country:US
Mailing Address - Phone:678-764-0631
Mailing Address - Fax:
Practice Address - Street 1:1913 MALONE CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-1119
Practice Address - Country:US
Practice Address - Phone:678-764-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist