JOHNATHAN EDWARD HENDERSON (NPI# 1154327856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154327856 |
| Entity Type | Individual |
| Full Name | JOHNATHAN EDWARD HENDERSON |
| Credential | M.D. |
| Practice Address |
304 Shorter Ave Nw Ste 201 Rome GA 30165 |
| Mailing Address |
420 E 2nd Ave Ste 103 Rome GA 30161-3210 |
| Practice Telephone | 7065093300 |
| Practice Fax Number | 7065093301 |
| Mailing Telephone | 7065093000 |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2018-08-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 054898 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | UNITED HEALTHCARE | 0103487 | 01 |
| GA | BCBS | 388021 | 01 |
| GA | KAISER PERMANENTE | 6313 | 01 |
| GA | RAILROAD RETIREMENT MEDIC | P00177381 | 01 |
| Street Address |
304 SHORTER AVE NW STE 201 |
| City | ROME |
| State | GA |
| Zip Code | 30165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568087708 | Nzota Pelagie Nsona Koyagialo | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2020-06-13 |
| 1912562927 | Romy Bhagat | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1710542725 | Ashley Corey | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1811552821 | Trever Biles | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1588229595 | Benjamin Steven Bell | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1528623535 | Diego Herrera | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1871158881 | Ra'shead Pompey | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1780249706 | Logan Minshew | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1871158840 | Jordan Moss | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1649763236 | Lacey Brooke Johnson | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2018-06-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447602347 | Tobias Jakobus Wallbrecher | Family Medicine | Via Domenico Silveri 30, Rome, ITALY 00165 | 2016-07-05 |
| 1346648250 | Free Clinic of Rome Georgia Inc | Family Medicine | 101-b John Maddox Drive, Rome, GA 30165-1419 | 2014-12-09 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1164745782 | Michael S. Jackson, Md, PC | Family Medicine | 701 E 2nd Ave Sw, Suite C, Rome, GA 30161-6148 | 2010-03-10 |
| 1477723120 | Michael Edward Gonsalves | Family Medicine | 4159 Martha Berry Hwy Nw, Rome, GA 30165-7705 | 2008-03-10 |
| 1013108661 | Alexis Ann Eckard | Family Medicine | 255 W 5th Street, Suite 300, Rome, GA 30165 | 2007-08-08 |
| 1134310147 | Reneka L Dobbs-jackson | Family Medicine | 420 E 2nd Ave Ste 103, Rome, GA 30161 | 2007-08-05 |
| 1265502926 | Thomas H. Pierzchala, M.d., P.C. | Family Medicine | 304a E 2nd Ave, Rome, GA 30161-3222 | 2006-11-09 |
| 1023198066 | Camille Dillard Do Health & Wellness PC | Family Medicine | 900 Erie Blvd W, Rome, NY 13440-2904 | 2006-10-16 |
| 1063504710 | Cheryl Reinhardt | Family Medicine | 5865 New Calhoun Hwy Ne, Rome, GA 30161-8253 | 2006-09-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.