Provider Demographics
NPI:1861032187
Name:MCLAUGHLIN, HEATHER (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 ROME ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3108
Mailing Address - Country:US
Mailing Address - Phone:770-462-1047
Mailing Address - Fax:
Practice Address - Street 1:497 ROME ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3108
Practice Address - Country:US
Practice Address - Phone:770-462-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014204207Q00000X, 363LF0000X
GARN204752207Q00000X, 207QH0002X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1861032187Medicaid