| Doctor Name: | HEATHER N BUMGARDNER |
| NPI Number: | 1679980668 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | RN192027 |
| Business Practice Address: | 7306 Ga Highway 21 Suite 106 Port Wentworth, GA - 314079274 |
| Business Phone Number: | 9128261500 |
| Business Fax Number: | 9128261531 |
| Mailing Address: | 7306 Ga Highway 21, Suite 106 PORT WENTWORTH |
| State: | GA |
| Postal Code: | 314079274 |
| Phone Number: | 9128261500 |
| Fax Number: | 9128261531 |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | RN192027 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |