Healthcare Provider Details

I. General information

NPI: 1790748994
Provider Name (Legal Business Name): HEATHER A MICHALAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NASHVILLE HWY
COLUMBIA TN
38401
US

IV. Provider business mailing address

1600 NASHVILLE HWY
COLUMBIA TN
38401
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-8965
  • Fax: 931-388-0815
Mailing address:
  • Phone: 931-388-8965
  • Fax: 931-388-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number238606
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD44004
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: