1477209468 NPI number — MR. JOHN HUBERT HEIL JR. MAPC S/T

Table of content: MR. JOHN HUBERT HEIL JR. MAPC S/T (NPI 1477209468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477209468 NPI number — MR. JOHN HUBERT HEIL JR. MAPC S/T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIL
Provider First Name:
JOHN
Provider Middle Name:
HUBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MAPC S/T
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477209468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 STARBOARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30642-4187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-515-0608
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3902 NORTHSIDE DR STE C1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-254-0481
Provider Business Practice Location Address Fax Number:
478-254-9723
Provider Enumeration Date:
02/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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