MEDICARE: DR. BRADLEY A HEIGES MD

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	050479	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871565481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY A HEIGES MD

Provider Business Mailing Address
First Line	:	210 E DERENNE AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405
Country	:	US
Telephone Number	:	912-644-5300
Fax Number	:	912-644-5300

Provider Business Practice Location Address
First Line	:	210 E DERENNE AVE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6736
Country	:	US
Telephone Number	:	912-644-5300
Fax Number	:	912-644-5260

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	10/23/2019

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