Provider Demographics
NPI:1275809733
Name:HEITZ, CHRISTOPHER T (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:HEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2175 HIGHWAY 75 STE 4
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5861
Mailing Address - Country:US
Mailing Address - Phone:423-323-5290
Mailing Address - Fax:423-323-5653
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-6711
Practice Address - Fax:423-224-6717
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2019-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN55596207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology