Healthcare Provider Details

I. General information

NPI: 1033146725
Provider Name (Legal Business Name): EVA MAE HENDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVA HENDERSON CAMARA M.D.

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WOODROW WILSON AVE
JACKSON MS
39213-7681
US

IV. Provider business mailing address

PO BOX 3437
JACKSON MS
39207-3437
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-5150
  • Fax: 601-709-5151
Mailing address:
  • Phone: 601-362-5321
  • Fax: 601-354-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10119
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: