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NPI Code Detail

MEDICARE: AUDREY HEATH

MEDICARE:   AUDREY  HEATH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1457977704
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY HEATH
Provider Business Mailing Address
First Line : 122 CYPRESS POINTE DR
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-4547
Country : US
Telephone Number : 407-437-4864
Fax Number :
Provider Business Practice Location Address
First Line : 740 E GENERAL STEWART WAY STE 103
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2636
Country : US
Telephone Number : 877-321-2899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2020
Last Update Date : 06/23/2020

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Directions to “ AUDREY HEATH ” Practice Location

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