Provider Demographics
NPI:1699947176
Name:JOHN M HENDERSON DO PC
Entity type:Organization
Organization Name:JOHN M HENDERSON DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MCKENZIE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:706-323-5717
Mailing Address - Street 1:1900 10TH AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3610
Mailing Address - Country:US
Mailing Address - Phone:706-323-5717
Mailing Address - Fax:706-323-6010
Practice Address - Street 1:1900 10TH AVE STE 320
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3610
Practice Address - Country:US
Practice Address - Phone:706-323-5717
Practice Address - Fax:706-323-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45629OtherUPIN
GAGRP6429OtherMEDICARE GROUP
GA08BBQVHOtherMEDICARE PROVIDER
GA025765OtherLICENSE
GA025765OtherLICENSE