Healthcare Provider Details

I. General information

NPI: 1770017543
Provider Name (Legal Business Name): KEITH ANTHONY HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3013
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-8383
  • Fax: 336-718-9622
Mailing address:
  • Phone: 336-718-8383
  • Fax: 336-718-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020-02868
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: