Provider Demographics
NPI:1770994618
Name:CASTLEBERRY, HEATHER (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27961 US HIGHWAY 98 STE 14
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4725
Mailing Address - Country:US
Mailing Address - Phone:251-626-1175
Mailing Address - Fax:251-625-1507
Practice Address - Street 1:27961 US HIGHWAY 98 STE 14
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4725
Practice Address - Country:US
Practice Address - Phone:251-626-1175
Practice Address - Fax:251-625-1507
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78532207Q00000X
AL42919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine