MEDICARE: ALBERT LEWIS HENRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME54173	FL
2	207XX0801X	Orthopaedic Trauma Physician	ME54173	FL

General Provider Information

NPI Number	:	1194705574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT LEWIS HENRY MD

Provider Business Mailing Address
First Line	:	6262 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3540
Country	:	US
Telephone Number	:	706-494-3071
Fax Number	:	706-494-3201

Provider Business Practice Location Address
First Line	:	4689 US HIGHWAY 17
Second Line	:	SUITE 11 &12
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4831
Country	:	US
Telephone Number	:	904-375-9753
Fax Number	:	904-375-8380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/25/2016

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