Provider Demographics
NPI:1952333411
Name:HENRY INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:HENRY INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:KURL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-289-0188
Mailing Address - Street 1:1016 HOSPITAL DRIVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:678-289-0188
Mailing Address - Fax:678-289-0187
Practice Address - Street 1:1016 HOSPITAL DR BLDG B
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7384
Practice Address - Country:US
Practice Address - Phone:678-289-0188
Practice Address - Fax:678-289-0187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045274305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF48660Medicare UPIN