Provider Demographics
NPI:1578261244
Name:DUDLEY, EDWARD E JR
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:E
Last Name:DUDLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 BARCLAY SQ S # QS
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3822
Mailing Address - Country:US
Mailing Address - Phone:205-260-9522
Mailing Address - Fax:
Practice Address - Street 1:2943 BARCLAY SQ S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3822
Practice Address - Country:US
Practice Address - Phone:205-260-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator