MEDICARE: DR. SCOTT DAVID HENDERSON 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
1	207Q00000X	Family Medicine Physician	026548	GA

General Provider Information

NPI Number	:	1801804000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT DAVID HENDERSON M.D.

Provider Business Mailing Address
First Line	:	1776 OLD SPRING HOUSE LN
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30338-6225
Country	:	US
Telephone Number	:	770-454-0091
Fax Number	:	770-454-0095

Provider Business Practice Location Address
First Line	:	1776 OLD SPRING HOUSE LN
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30338-6225
Country	:	US
Telephone Number	:	770-454-0091
Fax Number	:	770-454-0095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/07/2013

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