Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 064386 | GA |
N | 207VG0400X | Gynecologist | 31062 | AL |
NPI | 1013001627 |
---|---|
Provider Name | Teki Susan Hegwood |
First Address | Fort Stewart, GA 31314-4641 |
Second Address | Fort Stewart, GA 31314-4641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 14/12/2016 |