Provider Demographics
NPI:1891480794
Name:HEINEMANN, GEORGE CARL
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CARL
Last Name:HEINEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SOUTHLAND DR STE 224
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3736
Mailing Address - Country:US
Mailing Address - Phone:205-382-6222
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTHLAND DR STE 224
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35226-3736
Practice Address - Country:US
Practice Address - Phone:205-382-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
AL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker