Provider Demographics
NPI:1477185197
Name:HENDERSON, ALLEN (CERTIFIED HEALTH COA)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:CERTIFIED HEALTH COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ARLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2970
Mailing Address - Country:US
Mailing Address - Phone:770-912-1077
Mailing Address - Fax:
Practice Address - Street 1:152 ARLINGTON CT
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2970
Practice Address - Country:US
Practice Address - Phone:770-912-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator