Provider Demographics
NPI:1437469822
Name:ROBELLA, HEIDI N (PA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:N
Last Name:ROBELLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4299 TWO BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1545
Mailing Address - Country:US
Mailing Address - Phone:423-284-6705
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR STE C1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5621
Practice Address - Country:US
Practice Address - Phone:678-621-8100
Practice Address - Fax:844-313-9346
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant