Heather Suzanne Brock, PA
Individual provider Active NPI Medical Physician Assistant · Saint Simons Island, GA
NPI 1891744827 · NPPES record last updated May 19, 2016
Key facts
- NPI
- 1891744827
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 003270 (GA)
- Practice address
- 100 Saint Clair Pkwy
Saint Simons Island, GA 31522-1007 - Phone
- (678) 446-7351
- NPI assigned
- May 8, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060526000114 | GA | Practitioner - Physician Assistant | 8820009186 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003270 | GA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group of Georgia LLC | Current |
Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients | |
| Jafar Tabatabai M.D. P.C. | Past | Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients | |
| Paramount Health Group LLC | Past | Accepting new patients |
Locations
418 Eh Ct
Unit 4B
Brunswick, GA 31520
Phone (912) 267-0884
101 Yorktown Dr
Ste 100
Fayetteville, GA 30214
Phone (770) 460-4285
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 003270 | GA | Yes |
Addresses
Primary practice location
100 Saint Clair Pkwy
Saint Simons Island, GA 31522-1007
Mailing address
100 Saint Clair Pkwy
Saint Simons Island, GA 31522-1007
Phone (678) 446-7351
Other providers in Saint Simons Island, GA
- Brenda B Hollis, LPC, PC
- Laura Ann Brennan
- Mark Thomas Brinson
- Brissey Management Trust
- Rachel Skipper Brissey
- Austin Nicholas Brown
- Joshua D Brown
- Lori Marie Brown
- Jonathan Hunter Browning
- Robert Eric Bryan
All providers in Saint Simons Island, GA · Medical Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2016. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.