Individual
ELIZABETH HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 W LOUISVILLE AVE, ATMORE, AL 36502-1710
(251) 359-4480
(251) 368-2111
Mailing address
PO BOX 525, ATMORE, AL 36504-0525
(251) 359-4480
(251) 368-2111
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
359-052
AL
302R00000X
Health Maintenance Organization
M16000003277
FL
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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