Individual
HEATHER GIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
556 3RD ST STE A, MACON, GA 31201-7993
(478) 743-2472
Mailing address
556 3RD ST STE A, MACON, GA 31201-7993
(478) 743-2472
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8812
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1153909
NCCPA CERTIFICATION
GA
01
—
8812
PA LICENSE NUMBER
GA
Enumeration date
07/09/2018
Last updated
10/21/2019
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