Provider Demographics
NPI:1851855498
Name:GORE, HEATHER ANN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:GORE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:1900 TOWNE MANOR DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2979
Mailing Address - Country:US
Mailing Address - Phone:661-609-7842
Mailing Address - Fax:
Practice Address - Street 1:3903 S COBB DR SE STE 275
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6455
Practice Address - Country:US
Practice Address - Phone:404-251-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer