Individual
PHILIP NORTON HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPH, MBA
Contact information
Practice address
2696 LAWRENCEVILLE SUWANEE RD, SUWANEE, GA 30024-2535
(678) 376-1300
Mailing address
2696 LAWRENCEVILLE-SUWANEE RD, SUWANEE, GA 30024
(678) 376-1300
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
047601
GA
261QU0200X
Urgent Care Clinic/Center
Primary
047601
GA
261QX0100X
Occupational Medicine Clinic/Center
047601
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00851034C
—
GA
01
—
047601
STATE LICENSE NUMBER
GA
Enumeration date
07/14/2006
Last updated
03/07/2023
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