Healthcare Provider Details

I. General information

NPI: 1780140269
Provider Name (Legal Business Name): HEATHER DENISE CZARNECKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 DUG GAP RD
DALTON GA
30720-5007
US

IV. Provider business mailing address

1414 DUG GAP RD
DALTON GA
30720-5007
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-0405
  • Fax: 706-279-4190
Mailing address:
  • Phone: 706-279-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN185059
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: