Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 2015-00730 | NC |
N | 207L00000X | Anesthesiologist | 51542 | TN |
NPI | 1013237916 |
---|---|
Provider Name | Mary Jennette Judd |
First Address | Greensboro, NC 27408-7722 |
Second Address | Greensboro, NC 27408-7722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 18/08/2015 |