DR. EVERETT RANDALL HENDERSON III (NPI# 1609904515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609904515 |
| Entity Type | Individual |
| Full Name | DR. EVERETT RANDALL HENDERSON III |
| Credential | M.D. |
| Practice Address |
6051 U S Highway 49 Hattiesburg MS 39401-7200 |
| Mailing Address |
1108 Oakleigh Dr Hattiesburg MS 39402-3068 |
| Practice Telephone | 6012883440 |
| Practice Fax Number | 6012883451 |
| Mailing Telephone | 6012883440 |
| Mailing Fax Number | 6012883451 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
14669 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0117106 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861992083 | Everett Craig Henderson Jr. | Specialist/Technologist | 1600 Dodge Ave, Evanston, IL 60201-3449 | 2018-02-14 |
| Street Address |
6051 U S HIGHWAY 49 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-7200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497730469 | James A York | Radiology | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2005-12-13 |
| 1952908105 | Steven Matthew Hudson | Pharmacist | 6051 U S Highway 49, Hattiesburg, MS 39401-7201 | 2020-10-01 |
| 1336767748 | Zackery Johnson | Nurse Practitioner | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-07-12 |
| 1629698741 | Cassandra Wood | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-04-18 |
| 1376162438 | Michael Andrew Mclarty | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-04-09 |
| 1942829171 | Kaleb King | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7201 | 2020-04-08 |
| 1255950416 | Taylor Hairston | Student in an Organized Health Care Education/Training Program | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-04-08 |
| 1285263103 | Courtney Lynn Cruthirds | Registered Nurse | 6051 U S Highway 49, Hattiesburg, MS 39401-7201 | 2020-04-02 |
| 1609409440 | Relias Emergency Medicine Specialists of Hattiesburg LLC | Emergency Medicine | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2020-02-20 |
| 1205487238 | Ashley Harper Miles | Nurse Practitioner | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2019-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891743928 | R. Alan Brinson | Pediatrics | 5003 Hardy Street, Suite 302, Hattiesburg, MS 39402 | 2006-05-04 |
| 1548406606 | Ana Valeria Vera-sotomayor | Pediatrics | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2008-12-19 |
| 1376671255 | Clinton B White | Pediatrics | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2007-03-01 |
| 1639207541 | Kerry D Stewart | Pediatrics | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2007-03-01 |
| 1578691499 | Southern Mississippi Neonatology, Pa | Pediatrics | 6051 U S Highway 49, Hattiesburg, MS 39401-7200 | 2007-03-01 |
| 1982744348 | Hattiesburg Neonatology, Pllc | Pediatrics | 5003 Hardy St, Suite 302, Hattiesburg, MS 39402-1319 | 2007-02-07 |
| 1407846918 | Jose Mari S Yuvienco | Pediatrics | 5001 Hardy St, Hattiesburg, MS 39402-1308 | 2005-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487784898 | Newborn Associates P A | Pediatrics | 5 River Bend Pl Ste C, Flowood, MS 39232-7618 | 2007-03-06 |
| 1124104765 | Mitzi Gail Ferguson | Pediatrics | 1991 Lakeland Dr Ste C, Jackson, MS 39216-5000 | 2006-10-27 |
| 1457450058 | Mary Christina Glick | Pediatrics | 435 Katherine Drive, Suite B, Flowood, MS 39232 | 2006-09-21 |
| 1043264872 | Praveen Kumar | Pediatrics | 2500 N. State Street, Univ of Ms Med Ctr., Newborn Medicine, Jackson, MS 39216-4505 | 2006-05-19 |
| 1306806070 | Roland Leon Boyd | Pediatrics | 1730 14th St, C, Meridian, MS 39301-4140 | 2006-03-25 |
| 1235102906 | Ginger L Pole | Pediatrics | 4566 S Eason Blvd, Tupelo, MS 38801-6540 | 2006-02-10 |
| 1902381189 | William Needham | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2018-10-03 |
| 1215378658 | Jennifer Anne Caldwell | Pediatrics | 4500 13th Street, Gulfport, MS 39501 | 2013-07-15 |
| 1831536713 | William Ellison Smithhart | Pediatrics | 5 River Bend Pl Ste C, Flowood, MS 39232-7618 | 2013-05-31 |
| 1851659353 | Renjithkumar Kalikkot Thekkeveedu | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2012-05-03 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.