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NPI Code Detail

MEDICARE: EMILY J HERNDON M.D.

MEDICARE: EMILY J HERNDON 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 Physician35902GA

General Provider Information

NPI Number : 1962507640
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY J HERNDON M.D.
Provider Business Mailing Address
First Line : 3807 CLAIRMONT RD
Second Line :
City : CHAMBLEE
State : GA
Zip : 30341-4911
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3807 CLAIRMONT RD
Second Line :
City : CHAMBLEE
State : GA
Zip : 30341-4911
Country : US
Telephone Number : 770-454-1144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/27/2007

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