Basic Information
Provider Information
NPI: 1932592490
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEDLEY
FirstName: GARRETT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26222 RR 12
Address2:  
City: DRIPPING SPRINGS
State: TX
PostalCode: 786204903
CountryCode: US
TelephoneNumber: 5128580300
FaxNumber: 5128582714
Practice Location
Address1: 3316 WILLIAMS DR
Address2:  
City: GEORGETOWN
State: TX
PostalCode: 786282889
CountryCode: US
TelephoneNumber: 5125917818
FaxNumber: 5125977820
Other Information
ProviderEnumerationDate: 03/09/2015
LastUpdateDate: 03/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X80533TXY Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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