HENDERSON FAMILY PRACTICE, INC (NPI# 1629522032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629522032 |
| Entity Type | Organization |
| Organization Name | HENDERSON FAMILY PRACTICE, INC |
| Practice Address |
403 Lister St Suite A Waycross GA 31501-5225 |
| Practice Telephone | 9122834422 |
| Practice Fax Number | 9122834866 |
| Mailing Telephone | 9122834422 |
| Mailing Fax Number | 9122834866 |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |
| Authorized Official Name | MRS. LORI TAYMAN HENDERSON (FAMILY NURSE PRACTITIONER/OWNER) |
| Authorized Official Telephone | 9122834422 |
| Authorized Official Credential | NP-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
RN133742 | GA | Ambulatory Health Care Facilities |
| Street Address |
403 LISTER ST SUITE A |
| City | WAYCROSS |
| State | GA |
| Zip Code | 31501-5225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033508791 | Jacobs Clinic, Inc. | Nurse Practitioner | 403 Lister St, A, Waycross, GA 31501-5225 | 2015-01-20 |
| 1457894701 | James S. Blasko, M.d. P.C. | Family Medicine | 403 Lister St, Waycross, GA 31501-5225 | 2016-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962906115 | Davenport Health Pa | Family Medicine | 1401 Cherokee Drive, Waycross, GA 31501 | 2018-03-22 |
| 1962940478 | Blake Darren Aldridge | Physical Therapy Assistant | 401 Preston Street, Waycross, GA 31501 | 2017-02-03 |
| 1669922142 | Jebediah S. Christy Dds - Waycross Pllc | Dentist | 2271 Memorial Dr, Waycross, GA 31501 | 2016-10-10 |
| 1558721944 | Jana Kirby | Massage Therapist | 1599 Knight Ave., Kallman Chiropractic Center, Waycross, GA 31501 | 2016-02-29 |
| 1962877001 | Courtney Baldwin | Specialist/Technologist, Other | 2403 Spurgeon St, Waycross, GA 31501 | 2015-12-01 |
| 1912389784 | Grayson Stuart Griffis | Dentist | 2103 Tebeau St., Waycross, GA 31501 | 2015-06-29 |
| 1730561267 | Trishla Amit Desai | Internal Medicine | Memorial Satilla Health, 1900 Tebeau Street, Waycross, GA 31501 | 2015-06-20 |
| 1316330913 | Hanger Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 512 City Blvd Ste H, Waycross, GA 31501 | 2015-03-06 |
| 1942699079 | Jose Ramon Martinez | Anesthesiology | 701 City Blvd, Waycross, GA 31501 | 2015-01-13 |
| 1023356714 | Orthopedics Surgeons of Georgia, LLC | Orthopaedic Surgery | 2015 Alice Street, Waycross, GA 31501 | 2013-01-30 |
| Find all providers in zip 31501 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
| 1679957435 | Ware Weight Loss Center, LLC | Clinic/Center | 1710 1/2 Alice St, Waycross, GA 31501-5216 | 2015-07-11 |
| 1679083539 | Ware Express Care, LLC | Clinic/Center | 1411 Alice St, Waycross, GA 31501-4528 | 2017-10-05 |
| 1457613192 | Southeast Georgia Pediatrics | Clinic/Center | 1701 Boulevard Sq Ste D, Waycross, GA 31501-8022 | 2012-06-08 |
| 1043495963 | Beacon Pediatrics | Clinic/Center | 801 Beacon St, Waycross, GA 31501-7109 | 2008-01-09 |
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|---|---|---|---|---|
| 1942809108 | Lexington Primary Care LLC | Clinic/Center | 777 Athens Rd, Lexington, GA 30648-1902 | 2020-10-20 |
| 1619575834 | The Iv Spot, LLC. | Clinic/Center | 2100 Parklake Dr Ne # C-5, Atlanta, GA 30345-2824 | 2020-10-09 |
| 1528673514 | Safe Haven Medical Services | Clinic/Center | 444 Racetrack Rd, Mcdonough, GA 30252-6837 | 2020-09-15 |
| 1780296533 | North Atlanta Mental Wellness | Clinic/Center | 1742 Mount Vernon Rd Ste 150b, Atlanta, GA 30338-4251 | 2020-08-21 |
| 1639788136 | Walker Health and Wellness LLC | Clinic/Center | 111 Bradford Dr, Bloomingdale, GA 31302-4926 | 2020-07-30 |
| 1942827332 | Primary Care of Coastal Georgia | Clinic/Center | 214a Professional Cir, St Marys, GA 31558 | 2020-07-01 |
| 1598389637 | Mercie Health | Clinic/Center | 3721 New Macland Rd Ste 246, Powder Springs, GA 30127-2000 | 2020-06-04 |
| 1366061699 | Beyondmed LLC | Clinic/Center | 1820 Willow Branch Ln Nw, Kennesaw, GA 30152-4558 | 2020-04-16 |
| 1366082596 | Rock Health Inc | Clinic/Center | 5385 Five Forks Trickum Rd Ste F, Stone Mountain, GA 30087-3018 | 2020-01-15 |
| 1477192219 | Meridian Corporate Healthcare of Georgia P C | Clinic/Center | 5163 Thompson Bridge Rd, Murrayville, GA 30564-1930 | 2019-12-26 |
| Find all providers with the same taxonomy | ||||
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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.