Provider Demographics
NPI:1992788483
Name:HEINDEL, N HADLEY III (MD)
Entity type:Individual
Prefix:
First Name:N
Middle Name:HADLEY
Last Name:HEINDEL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2080 NEWNAN CROSSING BLVD E STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2557
Mailing Address - Country:US
Mailing Address - Phone:770-955-0270
Mailing Address - Fax:770-955-0271
Practice Address - Street 1:2080 NEWNAN CROSSING BLVD E STE 300
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2557
Practice Address - Country:US
Practice Address - Phone:770-955-0270
Practice Address - Fax:770-955-0271
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031939207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00500761BMedicaid
GAF27224Medicare UPIN
GA00500761BMedicaid