Henry, Glen A
Henry, Glen A is an individual health care provider with primary practice located at 200 S Enota Dr Ne Ste 200 , Gainesville GA 30501-3466. He recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Cardiology, which is considered as his primary health care specialty. Henry, Glen A can be contacted via phone (770) 534-2020.Contact Information
Primary practice address
200 S Enota Dr Ne Ste 200
Gainesville GA 30501-3466
Phone: (770) 534-2020
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 033328 | Connecticut |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 033328 | Georgia |
Profile Details
| NPI number | 1720077324 |
|---|---|
| LBN Legal business name | Henry, Glen A |
| Credentials | M.D., F.A.C.C. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 17th, 2005 |
| Last updated | Aug 30th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720077324 | NPPES |
| Connecticut | Other | 060050671 | MEDICARE RAILROAD PIN |
| Connecticut | MEDICAID | 001333286 | MEDICARE RAILROAD PIN |
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