MEDICARE: JILL HEATH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0805X	Geriatric Psychiatry Physician	34347	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40885	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1053428441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL HEATH

Provider Business Mailing Address
First Line	:	223 E CHESTNUT ST STE 4
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2480
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E CHESTNUT ST STE 4
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2480
Country	:	US
Telephone Number	:	828-350-8149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/13/2008

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