Provider Demographics
NPI:1427014059
Name:HENLEY, JOHN JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:HENLEY
Suffix:JR
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 1:1839 QUIET COVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3857
Mailing Address - Country:US
Mailing Address - Phone:910-323-1463
Mailing Address - Fax:910-323-1575
Practice Address - Street 1:1839 QUIET COVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3857
Practice Address - Country:US
Practice Address - Phone:910-323-1463
Practice Address - Fax:910-323-1575
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17991207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC41623OtherBCBS
NC8941623Medicaid
NC207191FMedicare ID - Type Unspecified
NC8941623Medicaid