Provider Demographics
NPI:1629268487
Name:SWEETWOOD, HEATHER TISON (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:TISON
Last Name:SWEETWOOD
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 STONEFOREST DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4881
Mailing Address - Country:US
Mailing Address - Phone:770-423-0595
Mailing Address - Fax:678-388-1627
Practice Address - Street 1:61 WHITCHER STREET NE
Practice Address - Street 2:SUITE 2100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5055
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2020-04-22
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005107OtherSTATE LICENSE