Healthcare Provider Details

I. General information

NPI: 1588697635
Provider Name (Legal Business Name): HEATHER A. PRYOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHEROKEE RD
CEDARTOWN GA
30125-4381
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 770-749-9600
  • Fax: 770-749-9628
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number044310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: