Healthcare Provider Details

I. General information

NPI: 1306484043
Provider Name (Legal Business Name): HEATHER MARIE SCRIMPSHIRE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 N COLLEGE ST
HAMILTON GA
31811-6031
US

IV. Provider business mailing address

250 MARTIN LUTHER KING JR BLVD
MACON GA
31201-3490
US

V. Phone/Fax

Practice location:
  • Phone: 762-267-0309
  • Fax: 762-267-0350
Mailing address:
  • Phone: 478-301-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209942
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: