Provider Demographics
NPI:1619160934
Name:LUDY, MICHAEL ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:LUDY
Suffix:
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 1:125 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-4952
Mailing Address - Country:US
Mailing Address - Phone:706-534-7838
Mailing Address - Fax:706-534-7838
Practice Address - Street 1:125 WESLEY RD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-4952
Practice Address - Country:US
Practice Address - Phone:706-534-7838
Practice Address - Fax:706-534-7838
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor