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General NPI Number Information
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NPI Number | 1023808094
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Entity Type | Individual
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Provider Name | MARY GRACE ELIZABETH HENDERSON RN
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Gender | Female
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 2220 N DRUID HILLS RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3117
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Country | US
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Telephone | 404-785-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 3546 SANDY WOODS LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4054
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Country | US
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Telephone | 770-625-0810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN308389
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License Number State | GA
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