Provider Demographics
NPI:1154325801
Name:MARLOW, HENRY GRADY III (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:GRADY
Last Name:MARLOW
Suffix:III
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 698
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-0698
Mailing Address - Country:US
Mailing Address - Phone:662-838-2163
Mailing Address - Fax:662-838-7944
Practice Address - Street 1:12 EAST BRUNSWICK
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-0698
Practice Address - Country:US
Practice Address - Phone:662-838-2163
Practice Address - Fax:662-838-7944
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117939Medicaid
MS00117939Medicaid
MS09226525Medicare ID - Type Unspecified