Healthcare Provider Details

I. General information

NPI: 1255736708
Provider Name (Legal Business Name): HEATHER SCOWDEN AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER PASS AA

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

1488 JESSE JEWELL PKWY SE STE 201
GAINESVILLE GA
30501-3804
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-7179
  • Fax: 770-534-1312
Mailing address:
  • Phone: 770-532-7179
  • Fax: 770-534-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA647
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number007374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: