Provider Demographics
NPI:1265520852
Name:HENDERSON, ALBERT EBEN (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:EBEN
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:330 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-4725
Mailing Address - Country:US
Mailing Address - Phone:912-258-4075
Mailing Address - Fax:912-634-2371
Practice Address - Street 1:330 OAK ST
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4725
Practice Address - Country:US
Practice Address - Phone:912-258-4075
Practice Address - Fax:912-634-2371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024849207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine