Individual
MISS KELA YVETTE HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
4585 NELSON BROGDON BLVD, SUGARHILL, GA 30518-3466
(770) 932-0547
(770) 932-4035
Mailing address
4585 NELSON BROGDON BLVD, SUGARHILL, GA 30518-3466
(770) 932-0547
(770) 932-4035
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
052117
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000976181B
—
GA
01
—
0102820
UNITED HEALTHCARE
GA
01
—
033620
AETNA HMO
GA
01
—
1398965006
CIGNA HEALTHCARE
GA
01
—
204624
BLUE CROSS BLUE SHIELD
GA
01
—
7806482
AETNA MANAGED CARE
GA
Enumeration date
05/09/2006
Last updated
03/18/2010
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