Provider Demographics
NPI:1154147361
Name:CASSIDY, HEATHER (CPS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0008
Mailing Address - Country:US
Mailing Address - Phone:706-212-0349
Mailing Address - Fax:
Practice Address - Street 1:633 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-5425
Practice Address - Country:US
Practice Address - Phone:706-212-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist