Provider Demographics
NPI:1487730628
Name:MCHENRY, MICHAEL ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:MCHENRY
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 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:2201 NEWNAN CROSSING BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2551
Practice Address - Country:US
Practice Address - Phone:770-460-4747
Practice Address - Fax:678-673-5102
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8053208100000X
IA38084208100000X
SD7369208100000X
GA65285208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00186848OtherMEDICARE RAILROAD
TX0021RJOtherBCBS
TX8AW792OtherBCBS
TX00648DOtherBCBS OF TEXAS
TX1312217-03Medicaid
GAP01099522OtherRR MEDICARE
GA202I252009Medicare PIN
TX0021RJOtherBCBS
GAP01099522OtherRR MEDICARE
TXF97842Medicare UPIN
IA479350008Medicare PIN
F97842Medicare UPIN
TXP00186848OtherMEDICARE RAILROAD