Healthcare Provider Details

I. General information

NPI: 1710064498
Provider Name (Legal Business Name): DOC HEILINBEL'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 DAWSON RD
ALBANY GA
31707-1323
US

IV. Provider business mailing address

2409 DAWSON RD
ALBANY GA
31707-1323
US

V. Phone/Fax

Practice location:
  • Phone: 229-889-9203
  • Fax: 229-888-8911
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009086
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CLEVELAND
Title or Position: OWNER PHARMACIST
Credential:
Phone: 229-889-9203