Provider Demographics
NPI:1285831008
Name:HEART2 HEART HEALTH
Entity Type:Organization
Organization Name:HEART2 HEART HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM.
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:404-763-4114
Mailing Address - Street 1:1750 LYLE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-1203
Mailing Address - Country:US
Mailing Address - Phone:404-763-4114
Mailing Address - Fax:404-763-4115
Practice Address - Street 1:1750 LYLE AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-1203
Practice Address - Country:US
Practice Address - Phone:404-763-4114
Practice Address - Fax:404-763-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031R0021376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty