Provider Demographics
NPI:1346784204
Name:HENDERSON, YOLANDA VASHUND (ND)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:VASHUND
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HIGHWAY 138 SW
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1502
Mailing Address - Country:US
Mailing Address - Phone:188-895-9209
Mailing Address - Fax:888-959-2093
Practice Address - Street 1:820 HIGHWAY 138 SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1502
Practice Address - Country:US
Practice Address - Phone:188-895-9209
Practice Address - Fax:888-959-2093
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
335E00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No335E00000XSuppliersProsthetic/Orthotic Supplier