Provider Demographics
NPI:1669406260
Name:HEDLEY, HALE E (MD)
Entity type:Individual
Prefix:DR
First Name:HALE
Middle Name:E
Last Name:HEDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 1704
Mailing Address - Street 2:#1704
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6298
Mailing Address - Country:US
Mailing Address - Phone:904-222-8500
Mailing Address - Fax:800-388-0270
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1704
Practice Address - Street 2:#1704
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:904-222-8500
Practice Address - Fax:800-388-0270
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94099207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29104OtherBCBS
FL273526100Medicaid
GA151937965AMedicaid
GA151937965AMedicaid
P00265565Medicare PIN
FLI46053Medicare UPIN