Provider Demographics
NPI:1124346325
Name:HEUSER, ANDREA MIKOL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MIKOL
Last Name:HEUSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:MIKOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6278
Mailing Address - Country:US
Mailing Address - Phone:912-350-5915
Mailing Address - Fax:912-350-5930
Practice Address - Street 1:4750 WATERS AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6278
Practice Address - Country:US
Practice Address - Phone:912-350-5915
Practice Address - Fax:912-350-5930
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36347208000000X
GA80856208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics