Provider Demographics
NPI:1962866392
Name:SCOON, HEDAYAH
Entity Type:Individual
Prefix:
First Name:HEDAYAH
Middle Name:
Last Name:SCOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11007 STONECREST TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2512
Mailing Address - Country:US
Mailing Address - Phone:678-720-6759
Mailing Address - Fax:
Practice Address - Street 1:11007 STONECREST TRL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2512
Practice Address - Country:US
Practice Address - Phone:678-720-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine