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NPI Code Detail

MEDICARE: GEORGE C HENDERSON JR. M.D.

MEDICARE: GEORGE C HENDERSON JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician013310LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285650713
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE C HENDERSON JR. M.D.
Provider Business Mailing Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-841-6048
Fax Number : 318-841-6044
Provider Business Practice Location Address
First Line : 1625 DAVID RAINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71107-5899
Country : US
Telephone Number : 318-841-6048
Fax Number : 318-841-6044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 10/19/2011

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