Provider Demographics
NPI:1447440748
Name:HENSARLING, KERRI FORRESTER (MD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:FORRESTER
Last Name:HENSARLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MEDICAL DR STE 405
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4145
Mailing Address - Country:US
Mailing Address - Phone:706-803-7690
Mailing Address - Fax:706-803-8803
Practice Address - Street 1:303 MEDICAL DR STE 405
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4145
Practice Address - Country:US
Practice Address - Phone:706-803-7690
Practice Address - Fax:706-803-8803
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28103207V00000X
GA97813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-44290OtherBCBS
AL009913488Medicaid