Provider Demographics
NPI:1023229887
Name:HENDERSON, MARGO LOUISE (FNP)
Entity type:Individual
Prefix:DR
First Name:MARGO
Middle Name:LOUISE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
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 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6917
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:STE 2B
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3190
Practice Address - Country:US
Practice Address - Phone:706-774-7400
Practice Address - Fax:706-774-7590
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily