Individual
KELLEY HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
231 W HANCOCK ST, MILLEDGEVILLE, GA 31061-3371
(478) 445-1076
Mailing address
2362 IVY MOUNTAIN DR, SNELLVILLE, GA 30078-8300
(404) 556-3049
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN220100
GA
Other
Enumeration date
03/07/2021
Last updated
03/07/2021
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