Healthcare Provider Details

I. General information

NPI: 1639149552
Provider Name (Legal Business Name): HENRY RONALD EMERY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 WEDDINGTON RD
WEDDINGTON NC
28104-8318
US

IV. Provider business mailing address

1928 WEDDINGTON RD
WEDDINGTON NC
28104-8318
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-4280
  • Fax: 704-667-4281
Mailing address:
  • Phone: 704-844-0505
  • Fax: 704-844-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40161
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00594
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200300594
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: