Provider Demographics
NPI:1700439585
Name:HEDGPETH, MARY KELLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY KELLY
Middle Name:
Last Name:HEDGPETH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A WASHINGTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4845
Mailing Address - Country:US
Mailing Address - Phone:478-925-6254
Mailing Address - Fax:
Practice Address - Street 1:275 PERRY PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9275
Practice Address - Country:US
Practice Address - Phone:478-218-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist