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General NPI Number Information
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NPI Number | 1699167684
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Entity Type | Individual
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Provider Name | ASHLEIGH ELISE HEATH NP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 643 MAIN ST
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City | PALMETTO
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State | GA
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Zip | 30268-1138
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Country | US
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Telephone | 770-626-4046
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 WALL ST
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City | JONESBORO
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State | GA
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Zip | 30236-2750
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Country | US
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Telephone | 404-717-4948
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 234314
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License Number State | GA
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