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General NPI Number Information
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NPI Number | 1841289279
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Entity Type | Individual
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Provider Name | ADELAIDE FRANCES HENDERSON MD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 2001 AIRPORT RD N SUITE 204
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City | FLOWOOD
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State | MS
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Zip | 39232-8827
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Country | US
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Telephone | 601-932-3191
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Fax | 601-936-7199
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Provider Business Mailing Address
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Address Line | 1503 HIGHWAY 45 N
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City | COLUMBUS
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State | MS
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Zip | 39705-2113
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Country | US
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Telephone | 662-328-9623
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Fax | 662-327-7477
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14341
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License Number State | MS
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