Provider Demographics
NPI:1740347483
Name:HAGER, HEATHER H (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:H
Last Name:HAGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:H
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3675 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1868
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:706-447-7120
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-824-3977
Practice Address - Fax:601-376-1684
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867584207P00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01529099Medicaid
MS302I500027OtherMEDICARE PTAN
LA1036781Medicaid
MS302I500027OtherMEDICARE PTAN
MS302I506665Medicare PIN