Provider Demographics
NPI:1114037561
Name:HEDEEN, CARLA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:A
Last Name:HEDEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1494
Mailing Address - Country:US
Mailing Address - Phone:404-501-7569
Mailing Address - Fax:404-501-7550
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 630
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-501-7569
Practice Address - Fax:404-501-7550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001656103G00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR12892Medicare UPIN
GA68BBDHKMedicare ID - Type Unspecified