Healthcare Provider Details

I. General information

NPI: 1265689665
Provider Name (Legal Business Name): CHELSEA S HENSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA S KEOWN N.P

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD STE 660
ATLANTA GA
30342-1608
US

IV. Provider business mailing address

3842 JACKS CREEK RD NW
MONROE GA
30655-5348
US

V. Phone/Fax

Practice location:
  • Phone: 404-847-1580
  • Fax: 404-303-2015
Mailing address:
  • Phone: 770-355-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN122848
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: