Provider Demographics
NPI:1528032596
Name:HEDAYA, ELLIS V (MD)
Entity Type:Individual
Prefix:
First Name:ELLIS
Middle Name:V
Last Name:HEDAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2209
Mailing Address - Country:US
Mailing Address - Phone:404-221-1899
Mailing Address - Fax:404-221-1343
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2209
Practice Address - Country:US
Practice Address - Phone:404-221-1899
Practice Address - Fax:404-221-1343
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0207332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40106Medicare UPIN
13BDCHMMedicare PIN