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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JONATHAN DOUGLAS HEAVEN MD
NPI 1114629755
Student in an Organized Health Care Education/Training Program in Atlanta, GA

Active since March 20, 2023PECOS Enrolled
12 EXECUTIVE PARK DR NE STE 200, ATLANTA, GA 30329(404) 712-6934 Get Directions Write a Review

NPPES record last updated: July 30, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jonathan Douglas Heaven Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JONATHAN DOUGLAS HEAVEN MD (NPI 1114629755) is an individual student in an organized health care education/training program in Atlanta, Georgia and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114629755
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJONATHAN DOUGLAS HEAVENCredential: MD
Location Address12 EXECUTIVE PARK DR NE STE 200Atlanta, GA 30329-2206
Mailing Address12 Executive Park Dr Ne Ste 200Atlanta, GA 30329-2206 · (404) 712-6934
Phone(404) 712-6934
Sole ProprietorNo
Enumeration DateMarch 20, 2023
Last NPPES UpdateJuly 30, 2026
NPPES CertifiedJuly 30, 2026
✔ NPI 1114629755 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
12 EXECUTIVE PARK DR NE STE 200, Atlanta, GA 30329
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jonathan Douglas Heaven Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. IYANUJESU ADERETI MBCHB
Student in an Organized Health Care Education/Training Program
12 EXECUTIVE PARK DR NE STE 200
ATLANTA, GA 30329
Dekalb County (404) 712-6934
DR. BIANCA MARKS MD
Psychiatry & Neurology (Child & Adolescent Psychiatry)
12 EXECUTIVE PARK DR NE STE 200
ATLANTA, GA 30329
Dekalb County (404) 712-6934
MILENA HIRATA ARMANI MD
Psychiatry & Neurology (Child & Adolescent Psychiatry)
12 EXECUTIVE PARK DR NE STE 200
ATLANTA, GA 30329
Dekalb County (404) 778-5526
DR. ANOOP SINGH TAKHER DO
Psychiatry & Neurology (Child & Adolescent Psychiatry)
12 EXECUTIVE PARK DR NE STE 200
ATLANTA, GA 30329
Dekalb County (630) 340-2340
DR. WILLIAM RILEY POWERS MD
Psychiatry & Neurology (Psychiatry)
12 EXECUTIVE PARK DR NE STE 200
ATLANTA, GA 30329
Dekalb County (404) 778-5526

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jonathan Heaven's NPI number?

The NPI number for Jonathan Heaven is 1114629755. It was assigned to this individual provider in the NPPES registry on March 20, 2023.

Where is Jonathan Heaven located?

Jonathan Heaven practices at 12 Executive Park Dr NE Ste 200, Atlanta, GA 30329. The listed phone number is (404) 712-6934.

What is Jonathan Heaven's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jonathan Heaven enrolled in Medicare?

Yes. Jonathan Heaven is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jonathan Heaven was last updated on July 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.