Individual
GEORGE C HENDERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 841-6048
(318) 841-6044
Mailing address
1625 DAVID RAINES RD, SHREVEPORT, LA 71107-5899
(318) 841-6048
(318) 841-6044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
013310
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1190519
—
LA
Enumeration date
07/15/2006
Last updated
10/19/2011
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