Organization
JOHN M HENDERSON DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MCKENZIE HENDERSON SR. DO (PRESIDENT)
(706) 323-5717
Entity
Organization
Contact information
Practice address
1900 10TH AVE STE 320, COLUMBUS, GA 31901-3610
(706) 323-5717
(706) 323-6010
Mailing address
1900 10TH AVE STE 320, COLUMBUS, GA 31901-3610
(706) 323-5717
(706) 323-6010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025765
LICENSE
GA
01
—
08BBQVH
MEDICARE PROVIDER
GA
01
—
D45629
UPIN
GA
01
—
GRP6429
MEDICARE GROUP
GA
Enumeration date
03/25/2008
Last updated
04/24/2024
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