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General NPI Number Information
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NPI Number | 1306993126
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Entity Type | Individual
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Provider Name | MICHELE HENSON MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 143 CANAL STREET SUITE 200
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-348-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 143 CANAL STREET SUITE 200
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-348-4100
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | ME115621
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 073306
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License Number State | GA
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