Provider Demographics
NPI:1104821594
Name:HEIN, BERNARD III (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:HEIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2563
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2529
Mailing Address - Country:US
Mailing Address - Phone:706-259-4435
Mailing Address - Fax:706-226-2283
Practice Address - Street 1:1200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2529
Practice Address - Country:US
Practice Address - Phone:706-259-4435
Practice Address - Fax:706-226-2283
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052577174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA663Z17573GMedicaid
GAP00081642OtherRAILROAD MEDICARE
GA663Z17573GMedicaid
GAH60958Medicare UPIN