Provider Demographics
NPI:1023253580
Name:MACADAM, HEATHER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:MACADAM
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2804 REMINGTON GREEN CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1550
Mailing Address - Country:US
Mailing Address - Phone:850-385-4494
Mailing Address - Fax:850-298-6054
Practice Address - Street 1:4100 S FERDON BLVD STE C5
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5287
Practice Address - Country:US
Practice Address - Phone:850-682-1164
Practice Address - Fax:850-682-5302
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2014-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 102536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005799600Medicaid