Provider Demographics
NPI:1487640090
Name:HEATH, GEORGE TILTON (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:TILTON
Last Name:HEATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 HILLCREST TRL
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9632
Mailing Address - Country:US
Mailing Address - Phone:757-869-2619
Mailing Address - Fax:
Practice Address - Street 1:400 SENTARA CIR STE 200
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5716
Practice Address - Country:US
Practice Address - Phone:757-345-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053809207L00000X, 207LP2900X
WI102354207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487640090Medicaid
VA1922031442Medicaid
VAP00147726OtherRAILROAD MEDICARE
VA010065453Medicaid
WI1487640090Medicaid
VA00V928P02Medicare PIN