Individual
DR. ANDREW TYLER HEFFERNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 HALTON VILLAGE CIR, GREENVILLE, SC 29607-6825
(229) 942-5646
Mailing address
115 HALTON VILLAGE CIR, GREENVILLE, SC 29607-6825
(229) 942-5646
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
83652
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83652
SC PERMANENT LICENSE NUMBER
SC
Enumeration date
04/20/2015
Last updated
06/30/2020
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