Provider Demographics
NPI:1578653200
Name:HENRY, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
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 1:4301 LAKE BOONE TRL STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7507
Mailing Address - Country:US
Mailing Address - Phone:919-890-5566
Mailing Address - Fax:919-896-7494
Practice Address - Street 1:4301 LAKE BOONE TRL STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7507
Practice Address - Country:US
Practice Address - Phone:919-890-5566
Practice Address - Fax:919-896-7494
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000-217932080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941718Medicaid
NCP00278496OtherRAILROAD
NC8941718Medicaid
NC207203Medicare PIN