Active NPI
Marcus Lee Hedrick, PHARMACIST
- Pharmacist
- Smyrna, GA
National Provider Identifier
1861091779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- GA017240
- Practice address
- 3240 S Cobb Dr SE
Smyrna, GA 30080-4194 - Phone
- (770) 433-3420
- NPI assigned
- Oct 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | GA017240 | GA | Primary |
Addresses
Primary practice location
3240 S Cobb Dr SE
Smyrna, GA 30080-4194
Mailing address
961 Durrell St
Austell, GA 30106-1405
Phone (678) 389-1841
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GA017240 | Other | GA | GA EPH LOS ENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA017240 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603238400000",
"number": "1861091779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "961 DURRELL ST",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061405",
"telephone_number": "678-389-1841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3240 S COBB DR SE",
"city": "SMYRNA",
"state": "GA",
"postal_code": "300804194",
"telephone_number": "770-433-3420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEDRICK",
"first_name": "MARCUS",
"middle_name": "LEE",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-21",
"last_updated": "2020-10-21",
"certification_date": "2020-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "GA017240",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA EPH LOS ENSE",
"identifier": "GA017240",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.