Healthcare Provider Details

I. General information

NPI: 1881570992
Provider Name (Legal Business Name): HEART OF RAPHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EAGLES WALK STE 150
STOCKBRIDGE GA
30281-7207
US

IV. Provider business mailing address

2831 LAKE JODECO RD
JONESBORO GA
30236-5335
US

V. Phone/Fax

Practice location:
  • Phone: 470-507-0029
  • Fax: 470-507-0030
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNE AURELIE NGO TEDGA MOCHE
Title or Position: OWNER
Credential: MD
Phone: 470-507-0029