Provider Demographics
NPI:1104848498
Name:HEFNER, DELORIS ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:ANN
Last Name:HEFNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5602
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:218 N FREDRICK ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-3242
Practice Address - Country:US
Practice Address - Phone:706-529-3643
Practice Address - Fax:706-374-7628
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN033755163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory