Provider Demographics
NPI:1215921176
Name:HEARD, DEREK J (MD)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:J
Last Name:HEARD
Suffix:
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 1:808 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1328
Mailing Address - Country:US
Mailing Address - Phone:229-312-7750
Mailing Address - Fax:229-889-7111
Practice Address - Street 1:808 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1328
Practice Address - Country:US
Practice Address - Phone:229-312-7750
Practice Address - Fax:229-889-7111
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891195BMedicaid
GA000891195HMedicaid
GA000891195BMedicaid
GA08BBRVWMedicare PIN