Healthcare Provider Details

I. General information

NPI: 1609389337
Provider Name (Legal Business Name): HEATH HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9275 BAY POINT DR
ELBERTA AL
36530-6561
US

IV. Provider business mailing address

24750 STATE ST UNIT 695
ELBERTA AL
36530-2024
US

V. Phone/Fax

Practice location:
  • Phone: 205-401-0976
  • Fax:
Mailing address:
  • Phone: 205-401-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA SUSANNE HEATH
Title or Position: OWNER
Credential: CRNP
Phone: 205-401-0976