Individual
HENRY L DEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 OGLETHORPE AVE, SUITE 3300, ATHENS, GA 30606-2190
(706) 208-1406
(706) 208-1407
Mailing address
1500 OGLETHORPE AVE, SUITE 3300, ATHENS, GA 30606-2190
(706) 208-1406
(706) 208-1407
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
027533
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000302915C
—
GA
01
—
52024243005
BLUE CROSS BLUE SHIELD
GA
01
—
P00053435
MEDICARE RAILROAD
GA
Enumeration date
03/27/2006
Last updated
01/31/2014
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