Healthcare Provider Details

I. General information

NPI: 1346784204
Provider Name (Legal Business Name): YOLANDA VASHUND HENDERSON N.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HIGHWAY 138 SW
RIVERDALE GA
30296-1502
US

IV. Provider business mailing address

820 HIGHWAY 138 SW
RIVERDALE GA
30296-1502
US

V. Phone/Fax

Practice location:
  • Phone: 188-895-9209
  • Fax: 888-959-2093
Mailing address:
  • Phone: 188-895-9209
  • Fax: 888-959-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: