Henry Clayton Dorminey Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

023352 Issued in GA

Practice address

820 Love Ave
Suite a
Tifton, GA 31794-4071

Phone

(229) 382-3720

Fax

(229) 382-3722

NPI assigned

Nov 14, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372032000000",
    "number": "1689655904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LOVE AVE",
            "address_2": "SUITE A",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944071",
            "telephone_number": "229-382-3720",
            "fax_number": "229-382-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LOVE AVE",
            "address_2": "SUITE A",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944071",
            "telephone_number": "229-382-3720",
            "fax_number": "229-382-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORMINEY",
        "first_name": "HENRY",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2013-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "023352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000239731A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Tifton, GA
• Providers in Tifton, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.