Individual
DR. GLEN A HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.C.
Contact information
Practice address
200 S ENOTA DR NE STE 200, GAINESVILLE, GA 30501-3466
(770) 534-2020
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
(770) 219-8840
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
033328
CT
207RI0011X
Interventional Cardiology Physician
Primary
033328
GA
207RI0011X
Interventional Cardiology Physician
MD21149
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001333286
—
CT
01
—
060050671
MEDICARE RAILROAD PIN
CT
Enumeration date
10/17/2005
Last updated
04/14/2026
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