Individual
MR. MATTHEW HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
150 CLINIC AVE STE 101, CARROLLTON, GA 30117-4402
(770) 834-0873
Mailing address
227 KRAMER ST, CARROLLTON, GA 30117-3705
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN239465
GA
Other
Enumeration date
09/24/2019
Last updated
09/24/2019
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