Provider Demographics
NPI:1114904042
Name:SAKOW, HENRY ARCHER (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:ARCHER
Last Name:SAKOW
Suffix:
Gender:M
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:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-1828
Mailing Address - Country:US
Mailing Address - Phone:229-312-7000
Mailing Address - Fax:229-312-7006
Practice Address - Street 1:500 W 3RD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1985
Practice Address - Country:US
Practice Address - Phone:229-312-7000
Practice Address - Fax:229-312-7006
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0238702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA390561429BMedicaid
GA390561429BMedicaid