Provider Demographics
NPI:1205189768
Name:JUDKINS, JESSIE MARIE (M S)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:MARIE
Last Name:JUDKINS
Suffix:
Gender:F
Credentials:M S
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 1027
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-1027
Mailing Address - Country:US
Mailing Address - Phone:229-259-5138
Mailing Address - Fax:229-245-6561
Practice Address - Street 1:206 S PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5668
Practice Address - Country:US
Practice Address - Phone:229-259-5138
Practice Address - Fax:229-245-6561
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator