Provider Demographics
NPI:1760528434
Name:HALL, HEATHER J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:6600 PEACHTREE DUNWOODY RD STE 325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6773
Mailing Address - Country:US
Mailing Address - Phone:404-876-1906
Mailing Address - Fax:
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 490
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:678-538-2167
Practice Address - Fax:678-538-2165
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA007729363AS0400X, 363AS0400X
IDPA881363AS0400X
MDC02958363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400130029Medicare PIN
ID20002590Medicare PIN