=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306484043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER MARIE SCRIMPSHIRE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2019
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 N COLLEGE ST
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31811-6031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 762-267-0309
-----------------------------------------------------
Fax | 762-267-0350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-301-4111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN209942
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------