Provider Demographics
NPI:1265689665
Name:HENSON, CHELSEA S (NP)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:S
Last Name:HENSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:S
Other - Last Name:KEOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3842 JACKS CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5348
Mailing Address - Country:US
Mailing Address - Phone:770-355-1829
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FERRY RD STE 660
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1608
Practice Address - Country:US
Practice Address - Phone:404-847-1580
Practice Address - Fax:404-303-2015
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122848363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA186430245BMedicaid