Healthcare Provider Details

I. General information

NPI: 1326449307
Provider Name (Legal Business Name): HUMPHREY HEYWOOD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 LEXINGTON ST
CHATTANOOGA TN
37405-3119
US

IV. Provider business mailing address

1506 LEXINGTON ST
CHATTANOOGA TN
37405-3119
US

V. Phone/Fax

Practice location:
  • Phone: 423-265-1377
  • Fax:
Mailing address:
  • Phone: 423-265-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD0000005865
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: