Individual
BRADLEY E. HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1061 HARMON AVE, STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6933
Mailing address
1061 HARMON AVE, STE1D03, FORT STEWART, GA 31314-5641
(912) 435-6933
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
030617
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000391025B
—
GA
05
—
000391025E
—
GA
Enumeration date
09/29/2005
Last updated
01/12/2009
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