Provider Demographics
NPI:1144003401
Name:WEBB, GEORGENA SUE
Entity type:Individual
Prefix:
First Name:GEORGENA
Middle Name:SUE
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 WALNUT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:510-301-9573
Mailing Address - Fax:510-225-3995
Practice Address - Street 1:183 WALNUT CIRCLE
Practice Address - Street 2:SAN FRANCISCO BAY AREA
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:510-301-9573
Practice Address - Fax:510-225-3995
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies