Individual
JUSTIN EDWARD HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 SKYLINE DR, DEATSVILLE, AL 36022-3135
(334) 730-5778
Mailing address
75 SKYLINE DR, DEATSVILLE, AL 36022-3135
(334) 730-5778
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
S12692
AL
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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