Healthcare Provider Details

I. General information

NPI: 1548239064
Provider Name (Legal Business Name): CAROL A HEEBNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL A FISCHER M.D.

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W CHURCH ST STE. E
BATESBURG-LEESVILLE SC
29006-2107
US

IV. Provider business mailing address

PO BOX 3788 SUITE 300
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-532-2208
  • Fax: 803-604-0207
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-217-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16619
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: