Shanda Danielle Henry, MS, LAT, ATC
Individual provider Active NPI Sports Medicine (Emergency Medicine) Physician · Tiger, GA
NPI 1265303804 · NPPES record last updated Sep 16, 2025
Key facts
- NPI
- 1265303804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Emergency Medicine) Physician 207PS0010X
- License
- AT002799 (GA)
- Practice address
- 230 Wildcat Trail
Tiger, GA 30576 - Phone
- (706) 490-1430
- NPI assigned
- Sep 16, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT002799 | GA | MD | Sports Medicine (Emergency Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | AT002799 | GA | Yes |
Addresses
Primary practice location
230 Wildcat Trail
Tiger, GA 30576
Mailing address
82 Sand Pump LN
Lakemont, GA 30552-2921
Phone (706) 490-1430
Other names
- Shanda Danielle Callenback
Other providers in Tiger, GA
- Marie Ann Church
- Piper L Coffey
- Megan Fonclara
- Elaina Noel Bristol Hinton
- Andrea Curran Howell
- Tanya Ann Hunt
- Mending Minds Therapeutic Services, LLC
- Janice B Robbins
All providers in Tiger, GA · Sports Medicine (Emergency Medicine) Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2025. 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.