Provider Demographics
NPI:1487250049
Name:AMY K HEESACKER, PHD, LLC
Entity Type:Organization
Organization Name:AMY K HEESACKER, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEESACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-460-3105
Mailing Address - Street 1:1551 JENNINGS MILL RD UNIT 2000B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7252
Mailing Address - Country:US
Mailing Address - Phone:706-460-3105
Mailing Address - Fax:
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 2000B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7252
Practice Address - Country:US
Practice Address - Phone:706-460-3105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service