Individual
MR. CLARE D HEIDLER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1497 FAIR RD, SUITE 102, STATESBORO, GA 30458-0822
(912) 486-1973
(912) 681-4184
Mailing address
1497 FAIR RD, SUITE 102, STATESBORO, GA 30458-0822
(912) 486-1973
(912) 681-4184
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
205653
SC
367500000X
Certified Registered Nurse Anesthetist
088676
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
19789
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GAN309
—
SC
Enumeration date
02/23/2012
Last updated
01/05/2022
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