Provider Demographics
NPI:1962568139
Name:HEWITT, DORIS WOODRUFF (PHD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:WOODRUFF
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DORIS
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1035 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1441
Mailing Address - Country:US
Mailing Address - Phone:404-366-3420
Mailing Address - Fax:404-608-1365
Practice Address - Street 1:1035 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1441
Practice Address - Country:US
Practice Address - Phone:404-366-3420
Practice Address - Fax:404-608-1365
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1569103TC0700X
GA106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBBVZMedicare ID - Type Unspecified