Provider Demographics
NPI:1184784647
Name:HEFFINGTON, STEPHEN H (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:HEFFINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2304 COUNTRY CLUB LN
Mailing Address - Street 2:SUITE 303B
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-5172
Mailing Address - Country:US
Mailing Address - Phone:931-334-1455
Mailing Address - Fax:
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-840-5088
Practice Address - Fax:931-840-5086
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN38435208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725470Medicaid
TN3894624Medicaid
TN4086717OtherBCBS TN
TN3894624Medicare PIN
TN3725470Medicaid
TNDD8774Medicare PIN
TN4086717OtherBCBS TN
TNP00257466Medicare PIN