Provider Demographics
NPI:1386388585
Name:HENDERSON, ANNA (MED)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1564
Mailing Address - Country:US
Mailing Address - Phone:770-712-0267
Mailing Address - Fax:
Practice Address - Street 1:375 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1564
Practice Address - Country:US
Practice Address - Phone:770-712-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist