Healthcare Provider Details

I. General information

NPI: 1851870430
Provider Name (Legal Business Name): JASON THOMAS HEFLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 LATONA DR SW
ATLANTA GA
30354-2366
US

IV. Provider business mailing address

3188 LATONA DR SW
ATLANTA GA
30354-2366
US

V. Phone/Fax

Practice location:
  • Phone: 404-337-9592
  • Fax:
Mailing address:
  • Phone: 404-337-9592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: