Individual
JOHN HEFFERNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 MEDICAL PARK WAY, AMERICUS, GA 31709-3656
(229) 924-7704
Mailing address
100 MEDICAL PARK WAY, AMERICUS, GA 31709-3656
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9350
GA
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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