MEDICARE: DR. JUSTINE ELODIA HENAO 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
1	207R00000X	Internal Medicine Physician	052580	GA
2	208M00000X	Hospitalist Physician	052580	GA
3	207R00000X	Internal Medicine Physician	U5861	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	52703489	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902808645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTINE ELODIA HENAO D.O.

Provider Business Mailing Address
First Line	:	1200 NORTHSIDE FORSYTH DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7659
Country	:	US
Telephone Number	:	770-844-3200
Fax Number	:	404-851-6325

Provider Business Practice Location Address
First Line	:	1200 NORTHSIDE FORSYTH DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7659
Country	:	US
Telephone Number	:	770-844-3200
Fax Number	:	404-851-6325

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/31/2023

Similar Medicare Providers

1558239210 — HOSNA GHADERI
Practice Location Address:

1200 NORTHSIDE FORSYTH DR
CUMMING, GA
30041-7659

Practice Phone: 770-844-3200
Practice Fax:

1164385241 — ERYN THACKER
Practice Location Address:

1200 NORTHSIDE FORSYTH DR
CUMMING, GA
30041-7659

Practice Phone: 770-844-3200
Practice Fax:

1427055482 — DR. MICHAEL C. SERGEANT MD
Practice Location Address:

1200 NORTHSIDE FORSYTH DR
CUMMING, GA
30041-7659

Practice Phone: 770-844-3200
Practice Fax: 404-851-6325

1487653283 — NORTHSIDE HOSPITAL
Practice Location Address:

1200 NORTHSIDE FORSYTH DR
CUMMING, GA
30041-7659

Practice Phone: 770-844-3396
Practice Fax: 770-844-3397

1841282472 — RAE LYNN BENTON RPH
Practice Location Address:

1200 NORTHSIDE FORSYTH DR , NORTHSIDE HOSPITAL FORSYTH PHARMACY
CUMMING, GA
30041-7659

Practice Phone: 770-844-3291
Practice Fax:

1356333868 — NORTHSIDE HOSPITAL
Practice Location Address:

1200 NORTHSIDE FORSYTH DR , NORTHSIDE HOSPITAL FORSYTH PHARMACY
CUMMING, GA
30041-7659

Practice Phone: 770-844-3291
Practice Fax: 770-844-3424

Directions to “ DR. JUSTINE ELODIA HENAO D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.