Provider Demographics
NPI:1326449307
Name:HEYWOOD, HUMPHREY III (MD)
Entity Type:Individual
Prefix:
First Name:HUMPHREY
Middle Name:
Last Name:HEYWOOD
Suffix:III
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 1:1506 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3119
Mailing Address - Country:US
Mailing Address - Phone:423-265-1377
Mailing Address - Fax:
Practice Address - Street 1:1506 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3119
Practice Address - Country:US
Practice Address - Phone:423-265-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000005865207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery