Amy K Heesacker, PHD, LLC
Organization Active NPI Point of Service · Watkinsville, GA
NPI 1487250049 · NPPES record last updated Dec 9, 2020
Key facts
- NPI
- 1487250049
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Point of Service 305S00000X
- Legal business name
- AMY K HEESACKER, PHD, LLC
- Practice address
- 1551 Jennings Mill Rd Unit 2000B
Watkinsville, GA 30677-7252 - Phone
- (706) 460-3105
- NPI assigned
- Dec 9, 2020
- Organization subpart
- No
Authorized official
- Name
- Dr. Amy K Heesacker, PHD
- Title
- Licensed Psychologist
- Phone
- (706) 460-3105
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210106002513 | GA | Part B Supplier - Clinic/Group Practice | 8123431376 |
Receives reassigned benefits from 1 practitioner Practice locations: Watkinsville, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Point of Service | 305S00000X | Yes |
Addresses
Primary practice location
1551 Jennings Mill Rd Unit 2000B
Watkinsville, GA 30677-7252
Mailing address
1551 Jennings Mill Rd Unit 2000B
Watkinsville, GA 30677-7252
Phone (706) 460-3105
Other providers in Watkinsville, GA
- Allison Deroeck Psychotherapy LLC
- Ana Alviz
- Amanda D Dyer, PHD, Inc
- Victoria Maxwell Amaral
- Ashley Amatriain
- David William Anderson
- Heather Corey Anderson
- Melissa M Anderson
- Cindy Andrews
- Heather James Anglin
All providers in Watkinsville, GA · Point of Service in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.