Healthcare Provider Details

I. General information

NPI: 1376703645
Provider Name (Legal Business Name): RICHARD ULF DAVID HEDELIUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

PO BOX 102847
ATLANTA GA
30368-2847
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-5478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number077391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: