Provider Demographics
NPI:1639149552
Name:EMERY, HENRY RONALD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:RONALD
Last Name:EMERY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 WEDDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8318
Mailing Address - Country:US
Mailing Address - Phone:704-844-0505
Mailing Address - Fax:704-844-0220
Practice Address - Street 1:1928 WEDDINGTON RD
Practice Address - Street 2:
Practice Address - City:WEDDINGTON
Practice Address - State:NC
Practice Address - Zip Code:28104-8318
Practice Address - Country:US
Practice Address - Phone:704-667-4280
Practice Address - Fax:704-667-4281
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC40161207Q00000X
NC00594207Q00000X
NC200300594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134FAMedicaid
SCQ0059WMedicaid
SCQ0059WMedicaid
2022387Medicare PIN
NC2022387AMedicare PIN
NCNC1769BMedicare PIN
NCNC1769AMedicare PIN