Provider Demographics
NPI:1730179466
Name:WEBSTER, MARY PATRICE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:PATRICE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:M PATRICIA
Other - Middle Name:WEBSTER
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31202-1775
Mailing Address - Country:US
Mailing Address - Phone:478-405-9945
Mailing Address - Fax:478-405-9951
Practice Address - Street 1:4112 ARKWRIGHT RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1707
Practice Address - Country:US
Practice Address - Phone:478-405-9945
Practice Address - Fax:478-405-9951
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03020782084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52261174OtherBLUE CROSS/BLUE SHIELD
GA52261174OtherBLUE CROSS/BLUE SHIELD
GA26BDBGNMedicare ID - Type Unspecified