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General NPI Number Information
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NPI Number | 1518223650
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Entity Type | Organization
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Legal Business Name | DR. WANDA D. HUGGET
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 700 MARTIN LUTHER KING JR DR
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City | FORT VALLEY
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State | GA
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Zip | 31030-4909
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Country | US
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Telephone | 478-216-8252
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Fax | 478-845-0478
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Provider Business Mailing Address
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Address Line | 700 MARTIN LUTHER KING JR DR
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City | FORT VALLEY
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State | GA
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Zip | 31030-4909
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Country | US
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Telephone | 478-216-8252
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Fax | 478-845-0478
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. WANDA D DENNIS HUGGET
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Credential | PHD
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Telephone | 478-216-8252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003531
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License Number State | GA
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