Provider Demographics
NPI:1518223650
Name:DR. WANDA D. HUGGET
Entity Type:Organization
Organization Name:DR. WANDA D. HUGGET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENNIS HUGGET
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:478-216-8252
Mailing Address - Street 1:700 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-4909
Mailing Address - Country:US
Mailing Address - Phone:478-216-8252
Mailing Address - Fax:478-845-0478
Practice Address - Street 1:700 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-4909
Practice Address - Country:US
Practice Address - Phone:478-216-8252
Practice Address - Fax:478-845-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N25800Medicare PIN