Individual
DR. JUSTINE ELODIA HENAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3200
(404) 851-6325
Mailing address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3200
(404) 851-6325
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
052580
GA
207R00000X
Internal Medicine Physician
Primary
U5861
TX
208M00000X
Hospitalist Physician
052580
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52703489
BLUE CROSS BLUE SHIELD
GA
05
—
608048816A
—
GA
Enumeration date
08/12/2005
Last updated
08/31/2023
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