Provider Demographics
NPI:1942528757
Name:HEINSCH, DAVID JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:HEINSCH
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 1:458 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3374
Mailing Address - Country:US
Mailing Address - Phone:770-842-1506
Mailing Address - Fax:
Practice Address - Street 1:1755 HIGHWAY 34 E
Practice Address - Street 2:SUITE 2200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5631
Practice Address - Country:US
Practice Address - Phone:770-502-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD455443207X00000X
GA69861207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I207556Medicare PIN