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General NPI Number Information
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NPI Number | 1023253580
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Entity Type | Individual
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Provider Name | HEATHER LYNN MACADAM MD
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Gender | Female
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 4100 S FERDON BLVD STE C5
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City | CRESTVIEW
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State | FL
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Zip | 32536-5287
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Country | US
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Telephone | 850-682-1164
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Fax | 850-682-5302
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Provider Business Mailing Address
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Address Line | 2804 REMINGTON GREEN CIR STE 2
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City | TALLAHASSEE
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State | FL
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Zip | 32308-1550
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Country | US
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Telephone | 850-385-4494
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Fax | 850-298-6054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME 102536
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License Number State | FL
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