Healthcare Provider Details

I. General information

NPI: 1831287127
Provider Name (Legal Business Name): HENRY MICHAEL BORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 US HIGHWAY 278 E
HOKES BLUFF AL
35903-7507
US

IV. Provider business mailing address

3871 US HIGHWAY 278 E
HOKES BLUFF AL
35903-7507
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-0544
  • Fax: 256-492-0558
Mailing address:
  • Phone: 256-492-0544
  • Fax: 256-492-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10586
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number10586
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: