Provider Demographics
NPI:1679824049
Name:HENRY, ALASDEEME JOSHUA (MD)
Entity Type:Individual
Prefix:MR
First Name:ALASDEEME
Middle Name:JOSHUA
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 1:5250 HIGHWAY 138
Mailing Address - Street 2:STE 4612
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6538
Mailing Address - Country:US
Mailing Address - Phone:678-509-5056
Mailing Address - Fax:678-509-5057
Practice Address - Street 1:5250 HIGHWAY 138
Practice Address - Street 2:STE 4612
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6538
Practice Address - Country:US
Practice Address - Phone:678-509-5056
Practice Address - Fax:678-509-5057
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001076768311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility