Provider Demographics
NPI:1629692066
Name:HENDERSON, SONJA (RN)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SONJA
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:304 EVERLY CIR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2088
Mailing Address - Country:US
Mailing Address - Phone:478-365-9062
Mailing Address - Fax:678-583-4499
Practice Address - Street 1:304 EVERLY CIR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2088
Practice Address - Country:US
Practice Address - Phone:478-365-9062
Practice Address - Fax:678-583-4499
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse