Provider Demographics
NPI:1003171943
Name:KOTULA, HEATHER GAIL (PAAA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:GAIL
Last Name:KOTULA
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:GAIL
Other - Last Name:RAGAZINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAAA
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-0669
Mailing Address - Country:US
Mailing Address - Phone:770-963-9905
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:770-963-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant