Provider Demographics
NPI:1063419216
Name:CHABOT, JUDITH T (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:T
Last Name:CHABOT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 LAKE SORRENTO DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-2739
Mailing Address - Country:US
Mailing Address - Phone:770-484-5423
Mailing Address - Fax:678-413-2030
Practice Address - Street 1:425 SIGMAN RD NW
Practice Address - Street 2:SUITE 109
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3635
Practice Address - Country:US
Practice Address - Phone:678-413-2026
Practice Address - Fax:678-413-2030
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF0803368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily