Individual
ELLENA HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1325 EASTMORELAND AVE STE 245, MEMPHIS, TN 38104-3591
(901) 516-9800
(901) 516-9817
Mailing address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39177
TN
207RI0200X
Infectious Disease Physician
39177
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3716661
—
TN
01
—
4097866
BCBS
TN
01
—
P00279007
RR MEDICARE
TN
Enumeration date
05/23/2006
Last updated
01/10/2024
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