Healthcare Provider Details

I. General information

NPI: 1316963358
Provider Name (Legal Business Name): PHILIP NORTON HENDERSON MD, MPH, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2696 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2535
US

IV. Provider business mailing address

2696 LAWRENCEVILLE-SUWANEE RD
SUWANEE GA
30024
US

V. Phone/Fax

Practice location:
  • Phone: 678-376-1300
  • Fax:
Mailing address:
  • Phone: 678-376-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number47601
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number047601
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number047601
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number047601
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: