Healthcare Provider Details

I. General information

NPI: 1275585606
Provider Name (Legal Business Name): DAVID WEBSTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE SUITE 1D03
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

1061 HARMON AVE SUITE 1D03
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-7417
  • Fax:
Mailing address:
  • Phone: 912-435-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0318P
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number646
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: