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General NPI Number Information
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NPI Number | 1578653200
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Entity Type | Individual
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Provider Name | GEORGE HENRY MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 4301 LAKE BOONE TRL STE 300
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City | RALEIGH
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State | NC
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Zip | 27607-7507
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Country | US
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Telephone | 919-890-5566
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Fax | 919-896-7494
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Provider Business Mailing Address
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Address Line | 4301 LAKE BOONE TRL STE 300
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City | RALEIGH
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State | NC
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Zip | 27607-7507
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Country | US
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Telephone | 919-890-5566
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Fax | 919-896-7494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0000-21793
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License Number State | NC
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