Individual provider Active NPI

Heather Marie Mathis, FNP-C

  • Family Nurse Practitioner
  • McDonough, GA
National Provider Identifier
1639470206
Registry record updated Oct 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN149754NP Issued in GA
Practice address
80 Candler Rd
McDonough, GA 30253-5455
Phone
(678) 432-8811
NPI assigned
Nov 12, 2010
Last updated
Oct 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN149754NP GA Primary

Addresses

Primary practice location

80 Candler Rd
McDonough, GA 30253-5455

Mailing address

80 Candler Rd
McDonough, GA 30253-5455

Other identifiers 1

IdentifierTypeStateIssuer
003113176AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN149754NPGAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Grace Hospice and Palliative Care CurrentSince Oct 21, 2025 Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Next Level Medical Management, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Locations

80 Candler Rd
McDonough, GA 30253
Phone (678) 432-8811

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760227200000",
    "number": "1639470206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 CANDLER RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 CANDLER RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535455",
            "telephone_number": "678-432-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "HEATHER",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-12",
        "last_updated": "2025-10-12",
        "certification_date": "2025-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN149754NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003113176A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.