Charles Dudleigh Hackett, PH.D.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT000579 Issued in GA

Practice address

316 Tea Berry LN.
Big Canoe, GA 30143-3014

Phone

(404) 375-0914

NPI assigned

Jul 9, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1194211631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10298 BIG CANOE",
            "city": "BIG CANOE",
            "state": "GA",
            "postal_code": "301435121",
            "telephone_number": "404-731-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 TEA BERRY LN.",
            "city": "BIG CANOE",
            "state": "GA",
            "postal_code": "301433014",
            "telephone_number": "404-375-0914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKETT",
        "first_name": "CHARLES",
        "middle_name": "DUDLEIGH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT000579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Big Canoe, GA
• Providers in Big Canoe, GA by specialty
• Marriage & Family Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.