Healthcare Provider Details

I. General information

NPI: 1124636352
Provider Name (Legal Business Name): HEATHER RACHELLE SENTER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 WATSON BLVD STE 4
WARNER ROBINS GA
31093-9527
US

IV. Provider business mailing address

3035 WATSON BLVD STE 4
WARNER ROBINS GA
31093-9527
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-0996
  • Fax: 678-802-0542
Mailing address:
  • Phone: 478-953-0996
  • Fax: 678-802-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS-001023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: