1265667760 NPI number — HEATHER CRANE AYERS CPNP-PC

Table of content: HEATHER CRANE AYERS CPNP-PC (NPI 1265667760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265667760 NPI number — HEATHER CRANE AYERS CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS
Provider First Name:
HEATHER
Provider Middle Name:
CRANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRANE
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP-PC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265667760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
163 SULLIVAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30547-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-865-2134
Provider Business Mailing Address Fax Number:
706-243-4613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3674 HABERSHAM MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMOREST
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30535-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-754-2630
Provider Business Practice Location Address Fax Number:
706-754-2634
Provider Enumeration Date:
05/28/2009

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: 363LP0200X , with the licence number:  RN164694 , 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: 191004405D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 527586 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 01313996 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 191004405B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191004405C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 527606 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 191004405A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 527602 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 191004405E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 527595 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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