Provider Demographics
NPI:1457315848
Name:BOGGESS, JUDITH J (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:J
Last Name:BOGGESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:JOY
Other - Last Name:BOGGESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1508 TOMBRAS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2720
Mailing Address - Country:US
Mailing Address - Phone:423-867-4969
Mailing Address - Fax:423-805-4213
Practice Address - Street 1:1508 TOMBRAS AVE
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-2720
Practice Address - Country:US
Practice Address - Phone:423-867-4969
Practice Address - Fax:423-805-4213
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE78471Medicare UPIN