Alicia Henderson
Individual provider Active NPI Home Modifications Contractor · Unadilla, GA
NPI 1013768936 · NPPES record last updated Mar 28, 2024
Key facts
- NPI
- 1013768936
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Modifications Contractor 171WH0202X
- License
- 99-2203499 (GA)
- Practice address
- 263 Bogan St
Unadilla, GA 31091-3798 - Phone
- (478) 235-9885
- NPI assigned
- Mar 28, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99-2203499 | GA | MD | Home Modifications Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 99-2203499 | GA | Yes |
Addresses
Primary practice location
263 Bogan St
Unadilla, GA 31091-3798
Mailing address
263 Bogan St
Unadilla, GA 31091-3798
Phone (478) 235-9885
Other providers in Unadilla, GA
- Marian A Conway
- Easy Living Care Home Inc
- Eugene Emory
- Tabatha Turner Hardwick
- Healthcare of Unadilla LLC
- Alexander Chukwuma Ibezi-Enendu
- Kimberly Crump Johnson
- Kristie Lashawn Lawson
- Leisure Life Care Home Inc
- Malozera Primary Care, LLC
All providers in Unadilla, GA · Home Modifications Contractor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.