Provider Demographics
NPI:1861198475
Name:HENDERSON, ANTONIO SR
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:HENDERSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0003
Mailing Address - Country:US
Mailing Address - Phone:843-782-3073
Mailing Address - Fax:
Practice Address - Street 1:528 WARREN ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3233
Practice Address - Country:US
Practice Address - Phone:843-284-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker