Provider Demographics
NPI:1245404037
Name:STACEY C. HEIT, M.D., P.C.
Entity Type:Organization
Organization Name:STACEY C. HEIT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:HEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-613-4745
Mailing Address - Street 1:11755 POINTE PL
Mailing Address - Street 2:SUITE A1
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4636
Mailing Address - Country:US
Mailing Address - Phone:678-613-4745
Mailing Address - Fax:770-667-2238
Practice Address - Street 1:11755 POINTE PL
Practice Address - Street 2:SUITE A1
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4636
Practice Address - Country:US
Practice Address - Phone:678-613-4745
Practice Address - Fax:770-667-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA413072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty