Provider Demographics
NPI:1548241557
Name:HENDERSON, RUBY LARNA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:LARNA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE STE 1275
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2240
Mailing Address - Country:US
Mailing Address - Phone:404-872-3121
Mailing Address - Fax:404-872-3119
Practice Address - Street 1:550 PEACHTREE STREET NE
Practice Address - Street 2:SUITE 1275
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-872-3121
Practice Address - Fax:404-872-3119
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN098527367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000701489Medicaid