Provider Demographics
NPI:1760032494
Name:HENDERSON, REBECCA CAMPBELL (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CAMPBELL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CAMPBELL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1614 VIRGINIA PINE CIR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5670
Mailing Address - Country:US
Mailing Address - Phone:404-797-2783
Mailing Address - Fax:
Practice Address - Street 1:1614 VIRGINIA PINE CIR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5670
Practice Address - Country:US
Practice Address - Phone:404-797-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine