Provider Demographics
NPI:1346979622
Name:HEIM, GREGORY W
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:HEIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 PROSPECT POINT DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-0350
Mailing Address - Country:US
Mailing Address - Phone:828-508-6070
Mailing Address - Fax:
Practice Address - Street 1:10 ECHOTA CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-0000
Practice Address - Country:US
Practice Address - Phone:828-359-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10604224Z00000X
GAOTA002861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant