Healthcare Provider Details

I. General information

NPI: 1104787340
Provider Name (Legal Business Name): ALLISON HEGWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTURY PKWY NE
ATLANTA GA
30345-3125
US

IV. Provider business mailing address

2600 CENTURY PKWY NE
ATLANTA GA
30345-3125
US

V. Phone/Fax

Practice location:
  • Phone: 470-322-1200
  • Fax:
Mailing address:
  • Phone: 470-322-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: