Healthcare Provider Details

I. General information

NPI: 1104848498
Provider Name (Legal Business Name): DELORIS ANN HEFNER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N FREDRICK ST
DALTON GA
30721-3242
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-529-3643
  • Fax: 706-374-7628
Mailing address:
  • Phone: 706-946-5602
  • Fax: 706-374-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN033755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: