MEDICARE: DR. KRISTI DAWN HENDERSON MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E-2181	AR
2	207Q00000X	Family Medicine Physician	K2922	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080181190	OTHER		MEDICARE RR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F1320	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5L214	OTHER	AR	BCBS
5	A013	OTHER		CHAMPUS
6	119401	OTHER		CHIPS

NPI Number	:	1164433298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI DAWN HENDERSON MD

Provider Business Mailing Address
First Line	:	900 N LOUISE ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-1725
Country	:	US
Telephone Number	:	903-556-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 S WILLIAM ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-3245
Country	:	US
Telephone Number	:	903-796-2868
Fax Number	:	903-796-0826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	01/14/2021

1007 S WILLIAM ST
ATLANTA, TX
75551-3245

Practice Phone: 903-799-3326
Practice Fax:

1011 SOUTH WILLIAMS STREET
ATLANTA, TX
75551-3245