Individual
GREGORY D HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8037
(843) 520-8403
Mailing address
612 CHERRY DR, SURFSIDE BEACH, SC 29575-4111
(843) 232-8078
(843) 232-0328
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN477
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0753
—
SC
01
—
P00123825
RAILROAD MEDICARE
SC
Enumeration date
07/22/2005
Last updated
07/08/2007
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