Healthcare Provider Details

I. General information

NPI: 1427016211
Provider Name (Legal Business Name): JOHN S HENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SECOND ST
MARIETTA OH
45750
US

IV. Provider business mailing address

611 SECOND ST
MARIETTA OH
45750
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-8756
  • Fax: 740-373-0091
Mailing address:
  • Phone: 740-373-8756
  • Fax: 740-373-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20112
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35077820
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: