Provider Demographics
NPI:1972568855
Name:HENDERSON, JAMES M JR (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:HENDERSON
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-1848
Practice Address - Fax:334-756-1854
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-031733367500000X
GARN050883367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1972568855OtherTRICARE STANDARD
GA842124961AMedicaid
GA1972568855OtherBC BS OF GA
ALP00135447OtherRAILROAD MEDICARE
AL051517972Medicaid
ALR51767Medicare UPIN
GA1972568855OtherBC BS OF GA