MEDICARE: GEORGE 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	2080P0202X	Pediatric Cardiology Physician	0000-21793	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00278496	OTHER	NC	RAILROAD

General Provider Information

NPI Number	:	1578653200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE HENRY MD

Provider Business Mailing Address
First Line	:	4301 LAKE BOONE TRL STE 300
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7507
Country	:	US
Telephone Number	:	919-890-5566
Fax Number	:	919-896-7494

Provider Business Practice Location Address
First Line	:	4301 LAKE BOONE TRL STE 300
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7507
Country	:	US
Telephone Number	:	919-890-5566
Fax Number	:	919-896-7494

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	06/11/2021

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