Individual
SHANDA DANIELLE HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
230 WILDCAT TRAIL, TIGER, GA 30576
(706) 490-1430
Mailing address
82 SAND PUMP LN, LAKEMONT, GA 30552-2921
(706) 490-1430
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
AT002799
GA
Other
Enumeration date
09/16/2025
Last updated
09/16/2025
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