Healthcare Provider Details

I. General information

NPI: 1255820676
Provider Name (Legal Business Name): ALECIA HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 MARLBORO ST
MARTINEZ GA
30907-3042
US

IV. Provider business mailing address

413 MARLBORO ST
MARTINEZ GA
30907-3042
US

V. Phone/Fax

Practice location:
  • Phone: 706-832-4324
  • Fax:
Mailing address:
  • Phone: 706-832-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO-080100
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: