Provider Demographics
NPI:1659597748
Name:BUDD, BILL ELI (PHD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:ELI
Last Name:BUDD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 WILDWOOD PL NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4958
Mailing Address - Country:US
Mailing Address - Phone:404-873-5517
Mailing Address - Fax:
Practice Address - Street 1:1817 WILDWOOD PL NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4958
Practice Address - Country:US
Practice Address - Phone:404-873-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical