Provider Demographics
NPI:1265434294
Name:HECHT, MITCHELL WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:WAYNE
Last Name:HECHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-475-0212
Mailing Address - Fax:770-410-0006
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-475-0212
Practice Address - Fax:770-410-0006
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00697012CMedicaid
GA11BDNNVMedicare ID - Type Unspecified
GA00697012CMedicaid