Provider Demographics
NPI:1801907761
Name:BOOTH, WILLIAM D (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:BOOTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1526 BENEDICT PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6763
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:334-725-3074
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:PAIN CLINIC (117)
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-5001
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-3074
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL778103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL778OtherSTATE PSYCHOOGIST LISCENS