Individual
DR. DANIEL LEE HEITHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
043386
GA
208600000X
Surgery Physician
Primary
30153
TN
208600000X
Surgery Physician
43386
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000796595C
—
GA
01
—
3824599
MEDICARE
TN
Enumeration date
07/26/2005
Last updated
08/15/2018
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