Provider Demographics
NPI:1902852965
Name:LEDBETTER, JUDY N
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:N
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:
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 303
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0303
Mailing Address - Country:US
Mailing Address - Phone:256-547-6119
Mailing Address - Fax:256-546-2981
Practice Address - Street 1:7583 WALL TRIANA HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-8327
Practice Address - Country:US
Practice Address - Phone:256-547-6119
Practice Address - Fax:256-546-2981
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBP9311856OtherDEA NUMBER