Individual
JASON MARC HEAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5653 BUFORD HWY NE, DORAVILLE, GA 30340-1200
(770) 396-2969
Mailing address
2874 MITCHELL CV NE, ATLANTA, GA 30319-2696
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1780
GA
Other
Enumeration date
11/06/2006
Last updated
04/29/2010
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