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NPI Code Detail

MEDICARE: CARY AUSTIN SANDERS HEFTY M.D.

MEDICARE: CARY AUSTIN SANDERS HEFTY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician069629GA
2207R00000XInternal Medicine Physician069629GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114154077
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARY AUSTIN SANDERS HEFTY M.D.
Provider Business Mailing Address
First Line : 119 HARMONY XING STE 3
Second Line :
City : EATONTON
State : GA
Zip : 31024-9571
Country : US
Telephone Number : 706-485-4004
Fax Number : 706-262-2986
Provider Business Practice Location Address
First Line : 119 HARMONY XING STE 3
Second Line :
City : EATONTON
State : GA
Zip : 31024-9571
Country : US
Telephone Number : 706-485-4004
Fax Number : 706-262-2986
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2009
Last Update Date : 08/14/2020

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