Provider Demographics
NPI:1699932327
Name:HEACOCK, MICHAEL NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NEIL
Last Name:HEACOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:191 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4109
Mailing Address - Country:US
Mailing Address - Phone:828-254-0881
Mailing Address - Fax:828-254-1614
Practice Address - Street 1:191 BILTMORE AVE
Practice Address - Street 2:ASHEVILLE GASTROENTEROLOGY ASSOCIATES, PA
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4109
Practice Address - Country:US
Practice Address - Phone:828-254-0881
Practice Address - Fax:828-254-1614
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00635207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1699932327Medicaid
NC1699932327Medicaid