Provider Demographics
NPI:1740276724
Name:HEARD, GEORGE J JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:HEARD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1224 TROTWOOD AVE
Mailing Address - Street 2:SOUTHERN RADIOLOGY ASSOCIATES, PLLC
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4802
Mailing Address - Country:US
Mailing Address - Phone:931-388-1286
Mailing Address - Fax:931-388-7119
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:SOUTHERN RADIOLOGY ASSOCIATES, LLC
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4802
Practice Address - Country:US
Practice Address - Phone:931-388-1286
Practice Address - Fax:931-388-7119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TNMD134982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN60383OtherBLUE CROSS PROVIDER NUMBE
TN3193100Medicaid
TNB04503Medicare UPIN
TN3193100Medicare ID - Type Unspecified