Individual
JOHNATHAN EDWARD HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
304 SHORTER AVE NW STE 201, ROME, GA 30165
(706) 509-3300
(706) 509-3301
Mailing address
420 E 2ND AVE STE 103, ROME, GA 30161-3210
(706) 509-3000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054898
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103487
UNITED HEALTHCARE
GA
01
—
388021
BCBS
GA
01
—
6313
KAISER PERMANENTE
GA
01
—
P00177381
RAILROAD RETIREMENT MEDIC
GA
Enumeration date
06/27/2005
Last updated
03/10/2023
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