Healthcare Provider Details

I. General information

NPI: 1457549164
Provider Name (Legal Business Name): JEFFREY D GEDDES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MEADOWLARK ST
SHAW AFB SC
29152-5019
US

IV. Provider business mailing address

431 MEADOWLARK ST
SHAW AFB SC
29152-5019
US

V. Phone/Fax

Practice location:
  • Phone: 830-895-4308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8144593-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: