NPIMap

Individual provider Active NPI

John Henderson IV, M.D.

  • Internal Medicine Physician
  • Macon, GA
National Provider Identifier
1346654407
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
078835 Issued in GA
Practice address
1327 Stadium Dr
Macon, GA 31207-1302
Phone
(478) 301-2382
Fax
(478) 301-2391
NPI assigned
Jun 17, 2014
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LL36863 SC
Internal Medicine Physician 207R00000X 078835 GA Primary

Addresses

Primary practice location

1327 Stadium Dr
Macon, GA 31207-1302

Mailing address

790 Lake Frances Dr Apt 5
Charleston, SC 29412-4337
Phone (678) 447-3683

Other practice location 1

96 Jonathan Lucas St Ste 803
Charleston, SC 29425-8900
Phone (843) 792-1020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171009000888 GA Practitioner - Internal Medicine 0840412797 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical University of South Carolina College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 Yorktown Dr
Fayetteville, GA 30214-1578

101 Yorktown Dr
Suite 100
Fayetteville, GA 30214-7663
Phone (770) 460-4285

1327 Stadium Dr
Macon, GA 31207-1302
Phone (478) 301-2696

250 Martin Luther King Jr Blvd
Macon, GA 31201-3490
Phone (478) 301-4111

764 Pine St
Macon, GA 31201-2107
Phone (478) 633-1721

777 Hemlock St
Macon, GA 31201-2102
Phone (478) 633-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
078835GAMDInternal Medicine Physician
LL36863SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Apr 30, 2024 Accepting new patients
Preston Family Medicine Inc CurrentSince Dec 10, 2018 Accepting new patients
The Corporation of Mercer University Internal Medicine Current Accepting new patients
Privia Medical Group of Georgia LLC Internal Medicine CurrentSince Apr 30, 2024 Accepting new patients
The Corporation of Mercer University CurrentSince Aug 28, 2017 Accepting new patients
Movement Sports Physical Therapy, LLC CurrentSince Aug 28, 2017 Accepting new patients
Privia Medical Group, LLC Internal Medicine Past Accepting new patients
The Medical Center of Central Georgia Inc Past Accepting new patients

Locations

101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285

1327 Stadium Dr
Macon, GA 31207
Phone (478) 301-2362

1550 College St
Macon, GA 31207
Phone (478) 301-2600

250 Mlk Blvd
Macon, GA 31201
Phone (478) 301-2362

6381 Hamilton St
Preston, GA 31824
Phone (229) 828-2118

Interoperability endpoints

  • Direct secure messaging: gmartinez446970@carolinashealthcaresystem.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/23051/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: john.henderson.1@8042.direct.athenahealth.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346654407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 LAKE FRANCES DR APT 5",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294124337",
            "telephone_number": "678-447-3683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 STADIUM DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312071302",
            "telephone_number": "478-301-2382",
            "fax_number": "478-301-2391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "96 Jonathan Lucas St Ste 803",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258900",
            "country_code": "US",
            "telephone_number": "843-792-1020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL36863",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "078835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.