Provider Demographics
NPI:1417060112
Name:DUDLEY, AINSWORTH GATEWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:AINSWORTH
Middle Name:GATEWOOD
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:MD
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 847
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0847
Mailing Address - Country:US
Mailing Address - Phone:229-928-4144
Mailing Address - Fax:229-928-3410
Practice Address - Street 1:401 S LEE ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3917
Practice Address - Country:US
Practice Address - Phone:229-924-8841
Practice Address - Fax:229-924-8857
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14046207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000014605GMedicaid
GA52025110-001OtherBCBS
GA000014605GMedicaid
GA52025110-001OtherBCBS