Provider Demographics
NPI:1215026208
Name:MATTHIAS, HEDDY DALE (MD)
Entity Type:Individual
Prefix:
First Name:HEDDY
Middle Name:DALE
Last Name:MATTHIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROSES BLUFF PKWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9230
Mailing Address - Country:US
Mailing Address - Phone:601-856-7074
Mailing Address - Fax:601-856-1744
Practice Address - Street 1:1 ROSES BLUFF PKWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9230
Practice Address - Country:US
Practice Address - Phone:601-856-7074
Practice Address - Fax:601-856-1744
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11130207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology