Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 030474 | GA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 030474 | GA |
NPI | 1427050491 |
---|---|
Provider Name | John D Henry JR. |
First Address | Atlanta, GA 30309-1476 |
Second Address | Atlanta, GA 30342-1705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00458653C | (05) | GA |
0486290001 | DME (01) | |
E83824 | (02) |