MEDICARE: DR. JUDY ANN KERLEY PH.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	103TC0700X	Clinical Psychologist	GA02400	GA

General Provider Information

NPI Number	:	1316019029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY ANN KERLEY PH.D.

Provider Business Mailing Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE 920
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	678-714-9590
Fax Number	:	678-714-9535

Provider Business Practice Location Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE 920
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	678-714-9590
Fax Number	:	678-714-9535

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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