Individual
GARY FLETCHER HEADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
1341 COLLEGE PARK RD, STE A, SUMMERVILLE, SC 29486-8635
(843) 400-0028
(843) 790-8449
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
15574
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155744
—
SC
Enumeration date
08/29/2006
Last updated
08/30/2018
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