John Caleb Henson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

006291 Issued in GA

Practice address

1300 Peachtree Industrial Blvd
Suite 4101
Suwanee, GA 30024-4539

Phone

(770) 831-5525

Fax

(770) 831-5527

NPI assigned

Jun 17, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402963200000",
    "number": "1730593815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 4101",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244539",
            "telephone_number": "770-831-5525",
            "fax_number": "770-831-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 4101",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244539",
            "telephone_number": "770-831-5525",
            "fax_number": "770-831-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENSON",
        "first_name": "JOHN",
        "middle_name": "CALEB",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-17",
        "last_updated": "2014-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Lorena Hernandez, CASE MANAGEMENT

• Medical Physician Assistant in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.