Provider Demographics
NPI:1164175840
Name:STILL, HEATHER RODEBAUGH (PA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RODEBAUGH
Last Name:STILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 CHRISTIANE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5568
Mailing Address - Country:US
Mailing Address - Phone:864-314-6196
Mailing Address - Fax:
Practice Address - Street 1:2508 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3266
Practice Address - Country:US
Practice Address - Phone:864-540-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine