Basic Information
| Provider Information | |||||||||
| NPI: | 1679980668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUMGARDNER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 W PERRY ST | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314013951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128261500 | ||||||||
| FaxNumber: | 9128261531 | ||||||||
| Practice Location | |||||||||
| Address1: | 7306 GA HIGHWAY 21 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | PORT WENTWORTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314079274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128261500 | ||||||||
| FaxNumber: | 9128261531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN192027 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.