Provider Demographics
NPI:1780821884
Name:HENDERSON, SHONTE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHONTE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1427
Mailing Address - Country:US
Mailing Address - Phone:404-366-3636
Mailing Address - Fax:
Practice Address - Street 1:4905 COURTNEY DR
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1427
Practice Address - Country:US
Practice Address - Phone:404-366-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062516208000000X
PAOS014543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics