Provider Demographics
NPI:1861549727
Name:HEAVRIN, JILL LAWTON (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LAWTON
Last Name:HEAVRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 W END AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2467
Mailing Address - Country:US
Mailing Address - Phone:407-222-1181
Mailing Address - Fax:
Practice Address - Street 1:555 HARTSVILLE PIKE
Practice Address - Street 2:SUMNER REGIONAL MEDICAL CENTER
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-328-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6159142207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine