Provider Demographics
NPI:1497778567
Name:HENRY, GARY WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:HENRY
Suffix:
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 1:520 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-1197
Mailing Address - Country:US
Mailing Address - Phone:704-624-3388
Mailing Address - Fax:704-624-3390
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1197
Practice Address - Country:US
Practice Address - Phone:704-624-3388
Practice Address - Fax:704-624-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE28518Medicare UPIN