MEDICARE: HEATHER D BUTLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	047710	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033116256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER D BUTLER M.D.

Provider Business Mailing Address
First Line	:	1485 JESSE JEWELL PKWY NE
Second Line	:	SUITE 200
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3806
Country	:	US
Telephone Number	:	770-534-5255
Fax Number	:	770-287-3871

Provider Business Practice Location Address
First Line	:	1485 JESSE JEWELL PKWY NE
Second Line	:	SUITE 200
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3806
Country	:	US
Telephone Number	:	770-534-5255
Fax Number	:	770-287-3871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	11/05/2012

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Directions to “ HEATHER D BUTLER M.D.” Practice Location

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