Healthcare Provider Details

I. General information

NPI: 1346625704
Provider Name (Legal Business Name): HEFNER TRANSITIONS MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RIVEREDGE PKWY SUITE 885
ATLANTA GA
30328-4694
US

IV. Provider business mailing address

2000 RIVEREDGE PKWY SUITE 885
ATLANTA GA
30328-4694
US

V. Phone/Fax

Practice location:
  • Phone: 844-633-4663
  • Fax: 877-489-3949
Mailing address:
  • Phone: 844-633-4663
  • Fax: 877-489-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN HEFNER
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 678-943-9444