Provider Demographics
NPI:1982880019
Name:HERITAGE MEDICAL SOLUTIONS, INC.
Entity Type:Organization
Organization Name:HERITAGE MEDICAL SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJONY
Authorized Official - Suffix:
Authorized Official - Credentials:BS/HND
Authorized Official - Phone:678-889-4944
Mailing Address - Street 1:4330 SOUTH LEE STREET
Mailing Address - Street 2:BLDG 600
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5754
Mailing Address - Country:US
Mailing Address - Phone:678-889-4944
Mailing Address - Fax:678-889-4946
Practice Address - Street 1:4330 SOUTH LEE STREET
Practice Address - Street 2:BLDG 600
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5754
Practice Address - Country:US
Practice Address - Phone:678-889-4944
Practice Address - Fax:678-889-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0477762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1023170842OtherNPI INDIVIDUAL
GA11662044OtherCAQH
GA097274712AMedicaid
GA097274712AMedicaid