DR. MARK WILLIAM HENDERSON (NPI# 1992792840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992792840 |
| Entity Type | Individual |
| Full Name | DR. MARK WILLIAM HENDERSON |
| Credential | DMD |
| Practice Address |
23d Medical Group 3278 Mitchell Blvd Moody Afb GA 31699-1500 |
| Practice Telephone | 2292571459 |
| Mailing Telephone | 2292571459 |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2018-04-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
5078 | AL | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255372868 | Mark T Henderson | Emergency Medicine | 3607 Fern Valley Rd Ste 102, Louisville, KY 40219-1916 | 2006-06-08 |
| 1639139876 | Mark Shea Henderson | Surgery | 135 Plaza Dr, Suite 202, Sikeston, MO 63801-5136 | 2006-03-23 |
| 1699245084 | Mark Henderson | Occupational Therapist | 28 Ritters Ridge Ct, Owings Mills, MD 21117-3355 | 2018-11-28 |
| 1760902498 | Mark E Henderson | Family Medicine | 4600 Valley Rd Ste 200, Lincoln, NE 68510-4882 | 2017-06-23 |
| 1407138167 | Mark Henderson | Pharmacist | 6958 Goodman Rd, Olive Branch, MS 38654-7034 | 2011-09-19 |
| 1184895856 | Mark C Henderson | Internal Medicine | 4860 Y St Ste 100, Sacramento, CA 95817-2307 | 2008-03-20 |
| 1912178229 | Mark Glen Henderson | Obstetrics & Gynecology | 2575 S Cimarron Rd, 102, Las Vegas, NV 89117-2682 | 2008-03-13 |
| 1841370707 | Mark A Henderson | Radiology | 2400 17th St, Columbus, IN 47201 | 2006-10-16 |
| 1891895272 | Mark Henderson | Internal Medicine | 900 Broadway, Bangor, ME 04401-1900 | 2006-09-25 |
| 1376562082 | Mark Reagan Henderson | Dentist | 5700 Arnold St, Tinker Afb, OK 73145-8105 | 2006-07-19 |
| Street Address |
23D MEDICAL GROUP 3278 MITCHELL BLVD |
| City | MOODY AFB |
| State | GA |
| Zip Code | 31699-1500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437526340 | George A Devita | Physician Assistant | 23d Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699-1793 | 2015-08-26 |
| 1295150266 | Bryan Presler | Psychologist | 23d Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2014-02-26 |
| 1750657680 | Tracey Anne White | Registered Nurse | 23d Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2012-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771876 | Aldo Enrique Revilla | Psychologist | Bermiss Rd, Moody Afb, Valdosta, GA 31699 | 2017-10-13 |
| 1699903146 | Elizabeth L Fauber | Military Health Care Provider | 9551 Luke Street, Apo, AP 31699 | 2009-06-23 |
| 1063646230 | James Michael White | Military Health Care Provider | 3278 Mithell Blvd, Bldg. 900, Moody Afb, GA 31699 | 2009-05-04 |
| 1265415590 | Rosalie Andrea Castillo | Family Medicine | 347th Medical Group, 3278 Mitchell Blvd, Valdosta, GA 31699 | 2005-11-21 |
| 1083147367 | Jordan Robbins | Dentist | 23rd Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699 | 2017-04-04 |
| 1912350877 | Sandra H Stuart | Dietitian, Registered | 3278 Mitchell Blvd, 23d Medical Group, Valdosta, GA 31699 | 2016-07-15 |
| 1407293418 | Clayton Lively | Psychiatry & Neurology | 3278 Mitchell Blvd, Moody Afb, GA 31699 | 2013-05-30 |
| 1174899371 | Vincent Casey Allen Jr. | Psychologist | 3278 Mitchell Blvd, Moody Afb, GA 31699 | 2012-04-01 |
| 1518364678 | Rachel Collins | Specialist/Technologist | 23 Mdos Sgoy, 3278 Mitchell Blvd, Moody Afb, GA 31699-0001 | 2014-12-04 |
| 1083988356 | Brock Allen Mcnabb | Social Worker | 23rd Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699-0001 | 2012-03-02 |
| Find all providers in zip 31699 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427659028 | My Emergency Dental Ga, LLC | Dentist | 4811 Lower Roswell Rd Ste 108, Marietta, GA 30068-4345 | 2020-11-02 |
| 1417556630 | Feyishayo Dahunsi | Dentist | 50 Main Street Market Pl Se Ste 500, Cartersville, GA 30121-3312 | 2020-10-19 |
| 1568079143 | Bimala Gharti | Dentist | 7310 Village Creek Trce, Atlanta, GA 30328-6763 | 2020-09-28 |
| 1760098214 | Georgia Dental Professionals, PC | Dentist | 3000 Chapel Hill Rd Ste 104, Douglasville, GA 30135-1841 | 2020-09-21 |
| 1063028769 | Georgia Dental Professionals, PC | Dentist | 3364 Hamilton Mill Rd, Buford, GA 30519-4005 | 2020-09-17 |
| 1306452016 | Georgia Dental Professionals, PC | Dentist | 2680 Highway 34 E Ste A, Newnan, GA 30265-1330 | 2020-09-17 |
| 1720693690 | Georgia Dental Professionals, PC | Dentist | 3625 Browns Bridge Rd Ste 101, Cumming, GA 30028-4198 | 2020-09-09 |
| 1699385062 | Hetal Trivedi | Dentist | 930 Spring St Nw Unit 915-a, Atlanta, GA 30309-3816 | 2020-07-31 |
| 1285242693 | Georgia Dental Professionals, PC | Dentist | 5185 Peachtree Pkwy Ste 201, Norcross, GA 30092-6539 | 2020-07-22 |
| 1770101131 | Fatima Hassan | Dentist | 722 Bonnie Oaks Ln, Evans, GA 30809-6114 | 2020-07-11 |
| 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.