Individual
PATRICK A. BOUDEWYNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-3141
(706) 721-6602
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 828-8401
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY000791
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000257771A
—
GA
05
—
PS0178
—
SC
Enumeration date
08/30/2006
Last updated
03/30/2011
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