Provider Demographics
NPI:1477549152
Name:HEAD, HAROLD DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:DAVID
Last Name:HEAD
Suffix:
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 1:2108 E 3RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2605
Mailing Address - Country:US
Mailing Address - Phone:423-624-5233
Mailing Address - Fax:423-624-4440
Practice Address - Street 1:2108 E 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2605
Practice Address - Country:US
Practice Address - Phone:423-624-5233
Practice Address - Fax:423-624-4440
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25570208G00000X
GA046421208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3082908Medicaid
TN3082900Medicare ID - Type Unspecified
A53270Medicare UPIN
GAGRP3449Medicare PIN