Healthcare Provider Details

I. General information

NPI: 1932418860
Provider Name (Legal Business Name): HENRY M BORN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

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

IV. Provider business mailing address

3871 OLD 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 TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY M BORN
Title or Position: PRESIDENT
Credential: MD
Phone: 256-492-0544