MEDICARE: DR. JEFFREY W. WEBB M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080S0010X	Pediatric Sports Medicine Physician	61372	GA

General Provider Information

NPI Number	:	1023039807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY W. WEBB M.D.

Provider Business Mailing Address
First Line	:	59 EXECUTIVE PARK S
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2208
Country	:	US
Telephone Number	:	404-778-7202
Fax Number	:	404-778-7266

Provider Business Practice Location Address
First Line	:	59 EXECUTIVE PARK S
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2208
Country	:	US
Telephone Number	:	404-778-7202
Fax Number	:	404-778-7266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/26/2017

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