Healthcare Provider Details

I. General information

NPI: 1578726055
Provider Name (Legal Business Name): HEATHER JANE BUZZETTI PA-C, AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 07/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1925 SPIKE PL
ALPHARETTA GA
30005-3663
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3900
  • Fax:
Mailing address:
  • Phone: 678-513-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004425
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: