Provider Demographics
NPI:1932263522
Name:HAMPTON, JUDY (EDS)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13034
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-3034
Mailing Address - Country:US
Mailing Address - Phone:478-714-8004
Mailing Address - Fax:866-412-5895
Practice Address - Street 1:6300 MOSELEY DIXON RD
Practice Address - Street 2:APT 207A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-8400
Practice Address - Country:US
Practice Address - Phone:478-714-8004
Practice Address - Fax:866-412-5895
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator