Provider Demographics
NPI:1174008460
Name:SALLING, JUDY E
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:E
Last Name:SALLING
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:PO BOX 3617
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-3617
Mailing Address - Country:US
Mailing Address - Phone:228-224-8561
Mailing Address - Fax:228-206-9526
Practice Address - Street 1:17232 EXCALIBUR CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3864
Practice Address - Country:US
Practice Address - Phone:228-365-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1148023172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver