Healthcare Provider Details

I. General information

NPI: 1013001627
Provider Name (Legal Business Name): TEKI SUSAN HEGWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE
FORT STEWART GA
31314-4641
US

IV. Provider business mailing address

1061 HARMON AVE
FORT STEWART GA
31314-4641
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-6965
  • Fax:
Mailing address:
  • Phone: 912-435-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number31062
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number064386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: