Healthcare Provider Details

I. General information

NPI: 1285515536
Provider Name (Legal Business Name): HEATHER ADCOCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 BURLEYSON RD
DALTON GA
30720-3181
US

IV. Provider business mailing address

3700 SUGAR VALLEY RD NW
SUGAR VALLEY GA
30746-5026
US

V. Phone/Fax

Practice location:
  • Phone: 423-664-4460
  • Fax:
Mailing address:
  • Phone: 706-271-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN175981
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: