Provider Demographics
NPI:1306378633
Name:PHAM, HEIDI MICHELLE (DNP, ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MICHELLE
Last Name:PHAM
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Gender:F
Credentials:DNP, ARNP, CNM
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Other - Middle Name:
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Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-223-9306
Mailing Address - Fax:404-223-9307
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-223-9306
Practice Address - Fax:404-223-9307
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60654131367A00000X
GARN267246367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife