Provider Demographics
NPI:1033405360
Name:HENDERSON-MARTIN, DEANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:HENDERSON-MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 DICKENS PL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1205
Mailing Address - Country:US
Mailing Address - Phone:901-289-2104
Mailing Address - Fax:
Practice Address - Street 1:462 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-9506
Practice Address - Country:US
Practice Address - Phone:706-868-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33857207R00000X
NV22003207RE0101X
GA076223207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine