Basic Information
| Provider Information | |||||||||
| NPI: | 1740276724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEARD | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1224 TROTWOOD AVE | ||||||||
| Address2: | SOUTHERN RADIOLOGY ASSOCIATES, PLLC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313881286 | ||||||||
| FaxNumber: | 9313887119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 TROTWOOD AVE | ||||||||
| Address2: | SOUTHERN RADIOLOGY ASSOCIATES, LLC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313881286 | ||||||||
| FaxNumber: | 9313887119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD13498 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 60383 | 01 | TN | BLUE CROSS PROVIDER NUMBE | OTHER | 3193100 | 05 | TN | MEDICAID |