Basic Information
| Provider Information | |||||||||
| NPI: | 1184784647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEFFINGTON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2304 COUNTRY CLUB LN | ||||||||
| Address2: | SUITE 303B | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384015172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313341455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1222 TROTWOOD AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384016436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318405088 | ||||||||
| FaxNumber: | 9318405086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 38435 | TN | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 3725470 | 05 | TN | MEDICAID | 3894624 | 05 | TN | MEDICAID | 4086717 | 01 | TN | BCBS TN | OTHER |