Provider Demographics
NPI:1902290976
Name:HERITAGE, CAROLITA BELLE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLITA
Middle Name:BELLE
Last Name:HERITAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLITA
Other - Middle Name:BELLE
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1012 BIG LANE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2331
Mailing Address - Country:US
Mailing Address - Phone:601-833-8157
Mailing Address - Fax:
Practice Address - Street 1:1012 D A BIGLANE DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2331
Practice Address - Country:US
Practice Address - Phone:601-833-8157
Practice Address - Fax:601-833-1633
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS25540207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program