Basic Information
| Provider Information | |||||||||
| NPI: | 1215240775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFSTADTER-DUKE | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 WATERS AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123508180 | ||||||||
| FaxNumber: | 9123505697 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 WHITE BLUFF RD STE 601 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124366789 | ||||||||
| FaxNumber: | 9124366835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY003639 | GA | N | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC2200X | PSY003639 | GA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | 003129989A | 05 | GA | MEDICAID | P01315374 | 01 | GA | RAILROAD MEDICARE | OTHER | 003129989C | 05 | GA | MEDICAID | 003129989B | 05 | GA | MEDICAID | PS0559 | 05 | SC | MEDICAID |