NPI 1013568740

Matthew Henderson, FNPC

Practitioner Nurse Practitioner Carrollton, GA

Practice location

Address: 150 Clinic Ave STE 101, Carrollton, GA 30117-4402
Phone: (770) 834-0873
Mailing address: 227 Kramer St, Carrollton, GA 30117-3705

Registered specialties

Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363L00000X Licence RN239465 (GA)

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Registry record

NPI: 1013568740
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Sep 2019
Record last updated: 24 Sep 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.