Healthcare Provider Details

I. General information

NPI: 1598567877
Provider Name (Legal Business Name): KRISTEN ROACH HEUERMAN APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN MEGAN ROACH

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 ATKINSON RD STE 100
LAWRENCEVILLE GA
30043-5004
US

IV. Provider business mailing address

1942 ATKINSON RD STE 100
LAWRENCEVILLE GA
30043-5004
US

V. Phone/Fax

Practice location:
  • Phone: 678-775-0600
  • Fax: 678-377-5284
Mailing address:
  • Phone: 678-775-0600
  • Fax: 678-377-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN302045
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN302045
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: