Healthcare Provider Details

I. General information

NPI: 1326005059
Provider Name (Legal Business Name): JEANNE E HENDRICKSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE ELISE MCCONATHY

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

111 RIDLEY CIR
DECATUR GA
30030-1118
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5050
  • Fax:
Mailing address:
  • Phone: 203-903-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number52156
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number049567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: