Healthcare Provider Details

I. General information

NPI: 1578657375
Provider Name (Legal Business Name): HEFFERNAN ASSALEY & LEE M D INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 12TH AVE
HUNTINGTON WV
25701-3833
US

IV. Provider business mailing address

1660 12TH AVE
HUNTINGTON WV
25701-3833
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-3420
  • Fax: 304-529-4645
Mailing address:
  • Phone: 304-522-3420
  • Fax: 304-529-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. APRIL DAWN WILLIAMSON
Title or Position: MEDICAL ASSISTANT
Credential: CRENTIALING MANAGER
Phone: 304-522-3420