Individual
JENNIFER L HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1571 HIGHWAY 21 S, SPRINGFIELD, GA 31329-3099
(912) 754-7500
(912) 754-7505
Mailing address
1571 HIGHWAY 21 S, SPRINGFIELD, GA 31329-5214
(912) 754-7500
(912) 754-7505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004058
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057423988A
—
GA
05
—
057423998B
—
GA
01
—
1005914
AMERIGROUP
GA
Enumeration date
06/23/2006
Last updated
03/05/2019
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