Provider Demographics
NPI:1871657569
Name:MCKAY, HENRY LEE (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:LEE
Last Name:MCKAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG 100D
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7380
Mailing Address - Country:US
Mailing Address - Phone:678-271-2833
Mailing Address - Fax:678-271-2834
Practice Address - Street 1:175 COUNTRY CLUB DR
Practice Address - Street 2:BLDG 100D
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7380
Practice Address - Country:US
Practice Address - Phone:678-271-2833
Practice Address - Fax:678-271-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52704229001OtherBCBS - GA
GA645081720AMedicaid
GAH73243Medicare UPIN
GA52704229001OtherBCBS - GA
GA645081720AMedicaid