MEDICARE: MISS KELA YVETTE HENRY M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	052117	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1398965006	OTHER	GA	CIGNA HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0102820	OTHER	GA	UNITED HEALTHCARE
4	033620	OTHER	GA	AETNA HMO
5	7806482	OTHER	GA	AETNA MANAGED CARE
6	204624	OTHER	GA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518916303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELA YVETTE HENRY M.D

Provider Business Mailing Address
First Line	:	4585 NELSON BROGDON BLVD
Second Line	:
City	:	SUGARHILL
State	:	GA
Zip	:	30518-3466
Country	:	US
Telephone Number	:	770-932-0547
Fax Number	:	770-932-4035

Provider Business Practice Location Address
First Line	:	4585 NELSON BROGDON BLVD
Second Line	:
City	:	SUGARHILL
State	:	GA
Zip	:	30518-3466
Country	:	US
Telephone Number	:	770-932-0547
Fax Number	:	770-932-4035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	03/18/2010

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Directions to “ MISS KELA YVETTE HENRY M.D” Practice Location

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