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NPI Code Detail

MEDICARE: DR. SHONTE HENDERSON D.O.

MEDICARE: DR. SHONTE HENDERSON D.O.
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
1208000000XPediatrics Physician062516GA
2208000000XPediatrics PhysicianOS014543PA

General Provider Information

NPI Number : 1780821884
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHONTE HENDERSON D.O.
Provider Business Mailing Address
First Line : 4905 COURTNEY DR
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-1427
Country : US
Telephone Number : 404-366-3636
Fax Number :
Provider Business Practice Location Address
First Line : 4905 COURTNEY DR
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-1427
Country : US
Telephone Number : 404-366-3636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2009
Last Update Date : 04/14/2022

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Directions to “ DR. SHONTE HENDERSON D.O.” Practice Location

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