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General NPI Number Information
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NPI Number | 1386825222
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Entity Type | Organization
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Legal Business Name | AUDREY HENDERSON M.D.P.C.
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2824 HILLCREEK DR
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City | AUGUSTA
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State | GA
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Zip | 30909-5628
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Country | US
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Telephone | 706-860-4567
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Fax | 706-860-4489
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Provider Business Mailing Address
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Address Line | 2824 HILL CREEK DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-860-4567
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Fax | 706-860-4489
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Authorized Official
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Title or Position | PRESIDENT
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Name | AUDREY M. HENDERSON
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Credential | M.D.
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Telephone | 706-860-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 029884
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License Number State | GA
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