Individual
MR. ANTONIO HENDERSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
487 BELLS HWY STE A, WALTERBORO, SC 29488-5740
(843) 782-3073
Mailing address
PO BOX 294, WALTERBORO, SC 29488-0003
(843) 782-3073
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
10017
SC
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
02/06/2023
Last updated
06/27/2025
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