# HEATHROW INTERNAL MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HEATHROW INTERNAL MEDICINE LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164191169
- **Legal business name:** HEATHROW INTERNAL MEDICINE LLC
- **Authorized official:** WILLIAM TEDRICK JOHNSON (VICE PRESIDENT)
- **Authorized official phone:** (615) 372-3375

## Contact information

- **Practice address:** 2209 S FRENCH AVE, SANFORD, FL 32771-4245
- **Practice address phone:** (407) 321-4230
- **Mailing address:** 2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
- **Mailing address phone:** (615) 372-5426

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/13/2021
- **Last updated:** 09/13/2021