Provider Demographics
NPI:1477713188
Name:HENNINGER, GRACE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:LEE
Last Name:HENNINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:SHOU-CHIAN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 EXECUTIVE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7588
Mailing Address - Country:US
Mailing Address - Phone:336-818-2177
Mailing Address - Fax:336-667-2213
Practice Address - Street 1:126 EXECUTIVE DR STE 110
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7588
Practice Address - Country:US
Practice Address - Phone:336-818-3177
Practice Address - Fax:336-667-2213
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110582207R00000X
NC2018-00052208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist