Provider Demographics
NPI:1841289279
Name:HENDERSON, ADELAIDE FRANCES (MD)
Entity type:Individual
Prefix:DR
First Name:ADELAIDE
Middle Name:FRANCES
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2113
Mailing Address - Country:US
Mailing Address - Phone:662-328-9623
Mailing Address - Fax:662-327-7477
Practice Address - Street 1:2001 AIRPORT RD N
Practice Address - Street 2:SUITE 204
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8827
Practice Address - Country:US
Practice Address - Phone:601-932-3191
Practice Address - Fax:601-936-7199
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116151Medicaid
MSF77730Medicare UPIN
MS00116151Medicaid