Healthcare Provider Details

I. General information

NPI: 1679980668
Provider Name (Legal Business Name): HEATHER N BUMGARDNER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7306 GA HIGHWAY 21 SUITE 106
PORT WENTWORTH GA
31407-9274
US

IV. Provider business mailing address

3 W PERRY ST SUITE 106
SAVANNAH GA
31401-3951
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-1500
  • Fax: 912-826-1531
Mailing address:
  • Phone: 912-826-1500
  • Fax: 912-826-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN192027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: