Provider Demographics
NPI:1902853401
Name:GUY MICHAEL HENRY, M.D., P.A.
Entity Type:Organization
Organization Name:GUY MICHAEL HENRY, M.D., P.A.
Other - Org Name:GRACE CLINIC FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-225-9905
Mailing Address - Street 1:9600 LILE DR
Mailing Address - Street 2:DOCTOR'S PARK BLDG. SUITE 250
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6326
Mailing Address - Country:US
Mailing Address - Phone:501-225-9905
Mailing Address - Fax:501-225-3323
Practice Address - Street 1:9600 LILE DR
Practice Address - Street 2:DOCTOR'S PARK BLDG. SUITE 250
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6326
Practice Address - Country:US
Practice Address - Phone:501-225-9905
Practice Address - Fax:501-225-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-3877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163053002Medicaid
ARDF4898Medicare PIN
AR163053002Medicaid