HENDERSON FAMILY PRACTICE INC NPI 1629522032

NPI Information

  • NPI: 1629522032
  • Provider Name: HENDERSON FAMILY PRACTICE, INC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 11D2118853
  • Address: 624 TEBEAU ST
    WAYCROSS, GA
    ZIP 31501
  • Phone: (912) 809-6052

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NPI Details

HENDERSON FAMILY PRACTICE, INC is a primary care clinic center in Waycross, GA. HENDERSON FAMILY PRACTICE, INC NPI is 1629522032. The provider is registered as an organization entity type.

The provider's business location address is:

624 TEBEAU ST
WAYCROSS, GA
ZIP 31501-728
Phone: (912) 809-6052
Fax: (912) 809-6070

The provider's authorized official is Lori Tayman Henderson .
The authorized official title is Family Nurse Practitioner/owner and has the following contact phone number (912) 809-6052.

The CLIA number assigned to this NPI record is 11D2118853 - practitioner other with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/15/2016 and was last updated on 10/31/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareRN133742GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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