Provider Demographics
NPI:1336271337
Name:WOLMAN, JUDY DRAISIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:DRAISIN
Last Name:WOLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 ROSWELL RD NE
Mailing Address - Street 2:#801
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4441
Mailing Address - Country:US
Mailing Address - Phone:404-816-5689
Mailing Address - Fax:404-255-3234
Practice Address - Street 1:6000 LAKE FORREST DR NW
Practice Address - Street 2:STE. 575
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3824
Practice Address - Country:US
Practice Address - Phone:404-255-1032
Practice Address - Fax:404-255-3234
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1019103TC2200X, 103TM1800X, 103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool