MEDICARE: HEATHER ANSARI

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1194285106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ANSARI

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PKWY NW STE 605
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PKWY NW STE 605
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2886
Country	:	US
Telephone Number	:	404-202-1392
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	06/11/2019

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Directions to “ HEATHER ANSARI ” Practice Location

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