Provider Demographics
NPI:1053470732
Name:HEDEN, ROBERT I (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:HEDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6452
Mailing Address - Country:US
Mailing Address - Phone:770-977-8221
Mailing Address - Fax:770-977-8222
Practice Address - Street 1:4439 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6452
Practice Address - Country:US
Practice Address - Phone:770-977-8221
Practice Address - Fax:770-977-8222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000457213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111132ASCAMedicare PIN
GAT97641Medicare UPIN
GA1753470732BMedicare PIN