Provider Demographics
NPI:1053782896
Name:MAJOR, HEATH JACKSON (MS, ATC)
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:JACKSON
Last Name:MAJOR
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 CROUCH DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-1513
Mailing Address - Country:US
Mailing Address - Phone:864-617-0324
Mailing Address - Fax:
Practice Address - Street 1:703 CROUCH DR
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-1513
Practice Address - Country:US
Practice Address - Phone:864-617-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer