Healthcare Provider Details

I. General information

NPI: 1003378738
Provider Name (Legal Business Name): HEC PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 REINHARDT COLLEGE PKWY STE 200
CANTON GA
30114-1700
US

IV. Provider business mailing address

157 REINHARDT COLLEGE PKWY STE 200
CANTON GA
30114-1700
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-7844
  • Fax: 678-494-7196
Mailing address:
  • Phone: 770-517-7844
  • Fax: 678-494-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HARRIET EYVONNE CADLE
Title or Position: OWNER
Credential: CFNP
Phone: 678-903-5143