Individual
DR. HENRY CLAYTON DORMINEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 LOVE AVE, SUITE A, TIFTON, GA 31794-4071
(229) 382-3720
(229) 382-3722
Mailing address
820 LOVE AVE, SUITE A, TIFTON, GA 31794-4071
(229) 382-3720
(229) 382-3722
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
023352
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000239731A
—
GA
Enumeration date
11/14/2005
Last updated
06/24/2013
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