Provider Demographics
NPI:1164518569
Name:HEATH, MARY DELPHINE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:DELPHINE
Last Name:HEATH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2409
Mailing Address - Country:US
Mailing Address - Phone:931-962-3199
Mailing Address - Fax:931-967-7818
Practice Address - Street 1:568 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2409
Practice Address - Country:US
Practice Address - Phone:931-962-3199
Practice Address - Fax:931-967-7818
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515467Medicaid
TN1871997841OtherGROUP NPI (SEWANEE PEDIATRICS)