Healthcare Provider Details

I. General information

NPI: 1235165119
Provider Name (Legal Business Name): HEATHER LYNN BLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 STARFIRE DR NE
ATLANTA GA
30345-3964
US

IV. Provider business mailing address

2120 STARFIRE DR NE
ATLANTA GA
30345-3964
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-329-2211
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number053374
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number053374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: