Provider Demographics
NPI:1194705574
Name:HENRY, ALBERT LEWIS (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:LEWIS
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3540
Mailing Address - Country:US
Mailing Address - Phone:706-494-3071
Mailing Address - Fax:706-494-3201
Practice Address - Street 1:4689 US HIGHWAY 17
Practice Address - Street 2:SUITE 11 &12
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4831
Practice Address - Country:US
Practice Address - Phone:904-375-9753
Practice Address - Fax:904-375-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54173207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC28840Medicare UPIN
FL07472UMedicare PIN
FLC28840Medicare UPIN
FL049024500Medicaid
FL4523030001Medicare NSC