Provider Demographics
NPI:1053582353
Name:SKELTON, HENRY GRADY III (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:GRADY
Last Name:SKELTON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1777 MONTREAL CIR
Mailing Address - Street 2:ANATOMIC PATHOLOGY
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6802
Mailing Address - Country:US
Mailing Address - Phone:678-406-1509
Mailing Address - Fax:770-621-7530
Practice Address - Street 1:1777 MONTREAL CIR
Practice Address - Street 2:ANATOMIC PATHOLOGY
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6802
Practice Address - Country:US
Practice Address - Phone:678-406-1509
Practice Address - Fax:770-621-7530
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2015-09-25
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Provider Licenses
StateLicense IDTaxonomies
VA0101032713207ZD0900X
AL00023737207ZD0900X
SC26892207ZD0900X
NC200400265207ZD0900X
PAMD247781207ZD0900X
FLME98759207ZD0900X
GA052870207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH29014Medicare UPIN