Healthcare Provider Details

I. General information

NPI: 1780647768
Provider Name (Legal Business Name): HEATHER H PEDRICK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TOWNPARK LN NW
KENNESAW GA
30144-5579
US

IV. Provider business mailing address

825 HENRY TURNER TRL
BALL GROUND GA
30107-7509
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN-CNM117446
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: