Individual
DR. JOHN MICHAEL HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MB, CHB, FRCS(ED), F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216
(601) 815-4700
(601) 815-5474
Mailing address
2500 N STATE ST, SUITE H 132, JACKSON, MS 39216
(601) 815-4700
(601) 815-5474
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
23977
MS
208600000X
Surgery Physician
35063394H
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0887296
—
OH
Enumeration date
06/22/2006
Last updated
09/17/2015
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