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General NPI Number Information
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NPI Number | 1346784204
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Entity Type | Individual
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Provider Name | YOLANDA VASHUND HENDERSON N.D
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Gender | Female
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 820 HIGHWAY 138 SW
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City | RIVERDALE
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State | GA
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Zip | 30296-1502
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Country | US
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Telephone | 188-895-9209
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Fax | 888-959-2093
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Provider Business Mailing Address
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Address Line | 820 HIGHWAY 138 SW
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City | RIVERDALE
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State | GA
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Zip | 30296-1502
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Country | US
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Telephone | 188-895-9209
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Fax | 888-959-2093
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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