Provider Demographics
NPI:1588697635
Name:PRYOR, HEATHER A (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:14 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-4381
Practice Address - Country:US
Practice Address - Phone:770-749-9600
Practice Address - Fax:770-749-9628
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000756115MMedicaid
GA000756115MMedicaid
GA511I080441Medicare PIN