MEDICARE: DR. JULIAN HENRY HEATH PSYD

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	103TC0700X	Clinical Psychologist	NONE	AL
2	103TC0700X	Clinical Psychologist	0810006441	VA

General Provider Information

NPI Number	:	1689230872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIAN HENRY HEATH PSYD

Provider Business Mailing Address
First Line	:	5001 SW 20TH ST APT 1502
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34474-8546
Country	:	US
Telephone Number	:	478-258-5438
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 SW 20TH ST APT 1502
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34474-8546
Country	:	US
Telephone Number	:	478-258-5438
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	12/23/2020

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