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Daniel Mark Henson

Internal Medicine

Allopathic & Osteopathic Physicians

1240 Jesse Jewell Pkwy SE, Ste 500, Gainesville, GA 30501-3861

PECOS Enrollment

This provider is enrolled in PECOS as DANIEL HENSON.

Based on the most recent information from CMS, provider Daniel Mark Henson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1780687756
Provider Type
Individual
Full Name
Henson, Daniel Mark
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/24/2005
Last Updated
3/2/2015

Contact Information

Practice Location

1240 Jesse Jewell Pkwy SE, Ste 500, Gainesville, GA 30501-3861

(770) 536-9864

(770) 297-5023

Mailing Location

1240 Jesse Jewell Pkwy SE, Suite 500, Gainesville, GA 30501-3862

(770) 536-9864

(770) 297-5023

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 025173 Georgia

Provider Identifiers

ID	Description	Issuer
ID 00285227B	Description Medicaid	Issuer Unlisted Georgia

Daniel Mark Henson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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