Organization
HERO HOUSE PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY HAVESON (CEO)
(949) 215-5796
Entity
Organization
Contact information
Practice address
1318 SHILOH TRAIL EAST NW, KENNESAW, GA 30144-2044
(949) 215-5795
Mailing address
510 GLENGATE CV, SANDY SPRINGS, GA 30328-7255
(949) 215-5795
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
—
Other
Enumeration date
03/27/2012
Last updated
01/27/2014
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