Provider Demographics
NPI:1821459074
Name:SORROW, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SORROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 KEITH DR
Mailing Address - Street 2:STE B
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4951
Mailing Address - Country:US
Mailing Address - Phone:478-988-0022
Mailing Address - Fax:478-987-0444
Practice Address - Street 1:1019 KEITH DR
Practice Address - Street 2:STE B
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4951
Practice Address - Country:US
Practice Address - Phone:478-988-0022
Practice Address - Fax:478-987-0444
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN175512OtherGEORGIA LICENSING NUMBER