Provider Demographics
NPI:1619213378
Name:ANDERSON, JUDITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 EAST VILLANOW STREET
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728
Mailing Address - Country:US
Mailing Address - Phone:706-638-1606
Mailing Address - Fax:706-638-9907
Practice Address - Street 1:611 EAST VILLANOW STREET
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728
Practice Address - Country:US
Practice Address - Phone:706-638-1606
Practice Address - Fax:706-638-9907
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26779208000000X
GA074892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics