Provider Demographics
NPI:1043500218
Name:CHUDY, CAROLYN THOMPSON (DO)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:THOMPSON
Last Name:CHUDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POWELL PL # 1441
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3622
Mailing Address - Country:US
Mailing Address - Phone:866-719-9611
Mailing Address - Fax:
Practice Address - Street 1:2908 POSTON AVE STE 2002
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1309
Practice Address - Country:US
Practice Address - Phone:866-719-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192092081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400105434Medicare UPIN