MEDICARE: HERITAGE MEDICAL INC

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	036658	GA

General Provider Information

NPI Number	:	1700975414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE MEDICAL INC

Provider Business Mailing Address
First Line	:	3300 MEMORIAL DR
Second Line	:	STE D4
City	:	DECATUR
State	:	GA
Zip	:	30032-2700
Country	:	US
Telephone Number	:	404-289-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 MEMORIAL DR
Second Line	:	STE D4
City	:	DECATUR
State	:	GA
Zip	:	30032-2700
Country	:	US
Telephone Number	:	404-289-2500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIUS B ODERINDE
Credential	:	MD
Telephone Number	:	404-289-2500

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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Directions to “HERITAGE MEDICAL INC ” Practice Location

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