Provider Demographics
NPI:1285662429
Name:HENLEY, DONALD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:HENLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5102 PAULSEN ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4601
Mailing Address - Country:US
Mailing Address - Phone:912-354-8331
Mailing Address - Fax:912-355-1832
Practice Address - Street 1:1 MEDICAL ARTS CTR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4414
Practice Address - Country:US
Practice Address - Phone:912-354-2232
Practice Address - Fax:912-354-6656
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024432208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00265713CMedicaid
GA00265713CMedicaid
GAD29731Medicare UPIN