MEDICARE: HEATHER MARIE INGRAM

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	363L00000X	Nurse Practitioner	NP715839	GA

General Provider Information

NPI Number	:	1801728803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE INGRAM

Provider Business Mailing Address
First Line	:	91 GREYSTONE CIR
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 GREYSTONE CIR
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3146
Country	:	US
Telephone Number	:	901-512-3761
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ HEATHER MARIE INGRAM ” Practice Location

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