Healthcare Provider Details

I. General information

NPI: 1760253280
Provider Name (Legal Business Name): HEATHER DOCKERY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 FANT DR
FORT OGLETHORPE GA
30742-3300
US

IV. Provider business mailing address

219 WATERS CEMETERY RD
STATESBORO GA
30458-3691
US

V. Phone/Fax

Practice location:
  • Phone: 912-314-7563
  • Fax: 912-216-3525
Mailing address:
  • Phone:
  • Fax: 912-216-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN325747
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: