Henderson, Audrey M

Henderson, Audrey M is an individual health care provider with primary practice located at 1109 Medical Center Dr Suite 3, Augusta GA 30909-6644. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Henderson, Audrey M can be contacted via phone (706) 860-4567.

Contact Information

Primary practice address
1109 Medical Center Dr Suite 3 Augusta GA 30909-6644
Phone: (706) 860-4567
Fax: (706) 860-4489
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 029884 Georgia
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X GA029884 Georgia

Profile Details

NPI number 1639161102
LBN Legal business name Henderson, Audrey M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 19th, 2005
Last updated Nov 16th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639161102 NPPES
Georgia MEDICAID 00383897A

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