Provider Demographics
NPI:1114300845
Name:HENDERSON, CHRISTOPHER TODD (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:151 PEACHWOOD CENTRE DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2575
Practice Address - Country:US
Practice Address - Phone:864-562-9627
Practice Address - Fax:864-560-5470
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC209578163W00000X
SC19769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC70246084OtherMEDICARE PIN
SCSC70246121OtherMEDICARE PIN
SCNP3439Medicaid
SCSC70246067OtherMEDICARE PIN
SCSC70245019OtherMEDICARE PIN
SCP01577397OtherRAILROAD MEDICARE
SCSC7024J577OtherMEDICARE PIN