MEDICARE: MARY C HEBBLEWHITE PHD

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	PSY001088	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760490536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C HEBBLEWHITE PHD

Provider Business Mailing Address
First Line	:	2200 CENTURY PKWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-3154
Country	:	US
Telephone Number	:	404-325-0304
Fax Number	:	404-325-3663

Provider Business Practice Location Address
First Line	:	2200 CENTURY PKWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-3154
Country	:	US
Telephone Number	:	404-325-0304
Fax Number	:	404-325-3663

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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