Provider Demographics
NPI:1740361153
Name:HANDEL, HEIDI SUE (DO)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUE
Last Name:HANDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3967
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3967
Mailing Address - Country:US
Mailing Address - Phone:706-737-9250
Mailing Address - Fax:706-733-0697
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-737-9250
Practice Address - Fax:706-733-0697
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052737207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA550789920OtherTRICARE
GA339268OtherWELLCARE CMO
GA756734701CMedicaid
GA003814OtherBCBS
GAP00195299OtherRRMEDICARE
SCG52737Medicaid
SCG52737Medicaid
GA339268OtherWELLCARE CMO