Roger Shawn Heatley

Primary specialty

DriverTaxonomy code 172A00000X

License

007056 Issued in SC

Practice address

230 Gene St
Bamberg, SC 29003-8245

Phone

(404) 285-0373

NPI assigned

Jan 8, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 1830 Logistics, LLC

  • Non-emergency Medical Transport (VAN)
  • Bamberg, SC
  • NPI 1154191369
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1013787217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 GENE ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290038245",
            "telephone_number": "404-285-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 GENE ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290038245",
            "telephone_number": "404-285-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEATLEY",
        "first_name": "ROGER",
        "middle_name": "SHAWN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "SC",
            "license": "007056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles L. Gaillard, M.D.
• Eva Gaillard, RN
• Sheryl Edgemon Gardner, RNC
• Richard Bernard Gunter, RPH
• Angela Hampton, PA-C
• Rosa Hill
• Meredith Cumbee Hipp, ACNP-BC
• Holly Hoffman, FNP-C
• Tonie Anthony Holman Sr.
• Alexander Hovey, PA-C

• All providers in Bamberg, SC
• Driver in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.