Provider Demographics
NPI:1225533375
Name:HENRY, GEORGIA ANN-MARIE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ANN-MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28538 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4791
Mailing Address - Country:US
Mailing Address - Phone:302-313-2298
Mailing Address - Fax:302-645-3691
Practice Address - Street 1:28538 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4791
Practice Address - Country:US
Practice Address - Phone:302-313-2298
Practice Address - Fax:302-645-3691
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020598207Q00000X
390200000X
DEC2-0023890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program