Provider Demographics
NPI:1568602589
Name:DRIESSEN, HEATHER D (DPM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:DRIESSEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SAINT JULIAN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2410
Mailing Address - Country:US
Mailing Address - Phone:803-256-6776
Mailing Address - Fax:803-256-6778
Practice Address - Street 1:1730 SAINT JULIAN PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2410
Practice Address - Country:US
Practice Address - Phone:803-256-6776
Practice Address - Fax:803-256-6778
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC625213ES0131X
GAPOD001173213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112634BMedicaid
GA003112634CMedicaid
GA1881541344Medicare UPIN