Healthcare Provider Details

I. General information

NPI: 1528823168
Provider Name (Legal Business Name): ERIN LEONARD HERNDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

IV. Provider business mailing address

1108 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-7546
  • Fax:
Mailing address:
  • Phone: 706-271-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: