1033444930 NPI number — MR. ALEXANDER HECKMAN PA-C

Table of content: MR. ALEXANDER HECKMAN PA-C (NPI 1033444930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033444930 NPI number — MR. ALEXANDER HECKMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HECKMAN
Provider First Name:
ALEXANDER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033444930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 NORTHSIDE FORSYTH DR
Provider Second Line Business Mailing Address:
STE 3500
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-667-4337
Provider Business Mailing Address Fax Number:
770-667-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 NORTHSIDE FORSYTH DR
Provider Second Line Business Practice Location Address:
STE 3500
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-667-4337
Provider Business Practice Location Address Fax Number:
770-667-4338
Provider Enumeration Date:
10/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA20597 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 007805 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003174364F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003174364E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003174364G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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