Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LL33857 | SC |
N | 111NI0900X | Internist | LL33857 | SC |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 076223 | GA |
NPI | 1033405360 |
---|---|
Provider Name | Dr. Deanna Henderson |
First Address | Atlanta, GA 30328-4307 |
Second Address | Atlanta, GA 30328-4307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 23/12/2016 |