Healthcare Provider Details

I. General information

NPI: 1053494831
Provider Name (Legal Business Name): DAVID GLEN MCHENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DRIVE SUITE 557
JACKSON MS
39216
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4560
  • Fax: 601-326-4632
Mailing address:
  • Phone: 225-526-0001
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number11473
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11473
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11473
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: