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General NPI Number Information
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NPI Number | 1528058765
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Entity Type | Individual
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Provider Name | REGGIE ALLAN HENDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 200 W CHURCH ST
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City | LEXINGTON
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State | TN
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Zip | 38351-2038
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Country | US
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Telephone | 731-968-3646
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Fax | 731-968-1870
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Provider Business Mailing Address
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Address Line | 200 W CHURCH ST
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City | LEXINGTON
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State | TN
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Zip | 38351-2038
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Country | US
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Telephone | 731-968-3646
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Fax | 731-968-1870
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 12019
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12019
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12019
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 12019
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 12019
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12019
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12019
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License Number State | TN
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