Provider Demographics
NPI:1215938980
Name:HERDA, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:HERDA
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 1:1616 GALLATIN PIKE N
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2104
Mailing Address - Country:US
Mailing Address - Phone:615-865-8500
Mailing Address - Fax:615-860-8061
Practice Address - Street 1:1616 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2104
Practice Address - Country:US
Practice Address - Phone:615-865-8500
Practice Address - Fax:615-860-8061
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14613208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3144727OtherBLUE CROSS BLUE SHIELD TN
TN103I012558Medicare PIN
TN3144727OtherBLUE CROSS BLUE SHIELD TN
TN38488101Medicare PIN
TN3848819Medicare PIN
TNA96920Medicare UPIN
TN3848811Medicare PIN
TN103I015163Medicare PIN
TN103I017590Medicare PIN