Organization
HERITAGE RADIOLOGY, PC
Active
Organization
HERITAGE RADIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIRIAM M WILLIS (SECRETARY)
(423) 942-1674
Entity
Organization
Contact information
Practice address
1000 HIGHWAY 28, GRANDVIEW MEDICAL CENTER, JASPER, TN 37347-3638
(423) 837-3423
Mailing address
195 MYERS AVE, P.O. BOX 128, GUILD, TN 37340-3099
(423) 942-1674
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3729274
—
TN
Enumeration date
01/13/2007
Last updated
08/22/2020
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