Provider Demographics
NPI:1063509321
Name:WEBB, JUDI LEE (PHD)
Entity Type:Individual
Prefix:
First Name:JUDI LEE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JUDI LEE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1827 POWERS FERRY ROAD
Mailing Address - Street 2:BUILDING 22 SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5621
Mailing Address - Country:US
Mailing Address - Phone:770-953-4744
Mailing Address - Fax:770-953-4640
Practice Address - Street 1:1827 POWERS FERRY ROAD
Practice Address - Street 2:BUILDING 22 SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5621
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:770-953-4640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10051809OtherAMERIGROUP
GA68BBGKRMedicare ID - Type Unspecified