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General NPI Number Information
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NPI Number | 1730166430
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Entity Type | Individual
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Provider Name | LISA E HEICHBERGER MD
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Gender | Female
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 50 E HOSPITAL ST STE 4
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City | MANNING
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State | SC
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Zip | 29102-3149
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Country | US
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Telephone | 803-435-8828
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Fax | 803-435-2239
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Provider Business Mailing Address
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Address Line | PO BOX 3239
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City | FLORENCE
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State | SC
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Zip | 29502-3239
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Country | US
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Telephone | 803-435-5270
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Fax | 803-433-0154
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23284
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License Number State | SC
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