Healthcare Provider Details

I. General information

NPI: 1740276724
Provider Name (Legal Business Name): GEORGE J HEARD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 TROTWOOD AVE SOUTHERN RADIOLOGY ASSOCIATES, LLC
COLUMBIA TN
38401-4802
US

IV. Provider business mailing address

1224 TROTWOOD AVE SOUTHERN RADIOLOGY ASSOCIATES, PLLC
COLUMBIA TN
38401-4802
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-1286
  • Fax: 931-388-7119
Mailing address:
  • Phone: 931-388-1286
  • Fax: 931-388-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD13498
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: