Provider Demographics
NPI:1578644324
Name:HENDERSON AND DARNELL ASSOCIATES
Entity Type:Organization
Organization Name:HENDERSON AND DARNELL ASSOCIATES
Other - Org Name:LAKESHORE FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-582-2581
Mailing Address - Street 1:2308 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2206
Mailing Address - Country:US
Mailing Address - Phone:256-582-2581
Mailing Address - Fax:256-582-7799
Practice Address - Street 1:2308 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2206
Practice Address - Country:US
Practice Address - Phone:256-582-2581
Practice Address - Fax:256-582-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528701550Medicaid
AL528701550Medicaid