Individual
DR. REGGIE ALLAN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W CHURCH ST, LEXINGTON, TN 38351-2038
(731) 968-3646
(731) 968-1870
Mailing address
200 W CHURCH ST, LEXINGTON, TN 38351-2038
(731) 968-3646
(731) 968-1870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
12019
TN
207Q00000X
Family Medicine Physician
Primary
12019
TN
207R00000X
Internal Medicine Physician
12019
TN
208000000X
Pediatrics Physician
12019
TN
208100000X
Physical Medicine & Rehabilitation Physician
12019
TN
2085R0202X
Diagnostic Radiology Physician
12019
TN
208600000X
Surgery Physician
12019
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152666
UNISON
TN
01
—
27415
TLC
TN
05
—
3189726
—
TN
01
—
4057341
BLUE CROSS BLUE SHIELD
TN
01
—
626001636
USA MANAGED CARE
TN
01
—
JT1012
CIGNA
TN
01
—
P00034973
RAILROAD MEDICARE
TN
Enumeration date
10/27/2005
Last updated
06/14/2024
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