MEDICARE: DEREK HELDZINGER PROFESSIONAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1508495326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEREK HELDZINGER PROFESSIONAL, LLC

Provider Business Mailing Address
First Line	:	102 RBC DR
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2787
Country	:	US
Telephone Number	:	814-243-0414
Fax Number	:	814-479-5906

Provider Business Practice Location Address
First Line	:	102 RBC DR
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-2787
Country	:	US
Telephone Number	:	814-243-0414
Fax Number	:	814-479-5906

Authorized Official
Title or Position	:	DOCTOR OF MEDICINE/OWNER
Name	:	DEREK HELDZINGER
Credential	:	MD
Telephone Number	:	423-827-9222

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	02/28/2024

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