Healthcare Provider Details

I. General information

NPI: 1528025228
Provider Name (Legal Business Name): JOHN G HELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN GAYLORD HELLER

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 EXECUTIVE PARK SOUTH NE STE 3000
ATLANTA GA
30329
US

IV. Provider business mailing address

59 EXECUTIVE PARK SOUTH NE STE 3000
ATLANTA GA
30329
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3350
  • Fax: 404-778-6334
Mailing address:
  • Phone: 404-778-3350
  • Fax: 404-778-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number031940
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number031940
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: