Provider Demographics
NPI:1831287127
Name:BORN, HENRY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:MICHAEL
Last Name:BORN
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 1:3871 US HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:HOKES BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35903-7507
Mailing Address - Country:US
Mailing Address - Phone:256-492-0544
Mailing Address - Fax:256-492-0558
Practice Address - Street 1:3871 US HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:HOKES BLUFF
Practice Address - State:AL
Practice Address - Zip Code:35903-7507
Practice Address - Country:US
Practice Address - Phone:256-492-0544
Practice Address - Fax:256-492-0558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10586207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009953560Medicaid
AL51503789OtherBCBS OF AL
AL009953560Medicaid
AL51503789OtherBCBS OF AL