Provider Demographics
NPI:1023083946
Name:JUDY, CHARLES GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GERALD
Last Name:JUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:GERALD
Other - Last Name:JUDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:502 GOVERNORS DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5126
Mailing Address - Country:US
Mailing Address - Phone:256-533-0833
Mailing Address - Fax:256-533-0855
Practice Address - Street 1:502 GOVERNORS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5126
Practice Address - Country:US
Practice Address - Phone:256-533-0833
Practice Address - Fax:256-533-0855
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL259472080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009951755Medicaid
AL051521002JUDOtherBKUE CROSS PROVIDER #
AL009951755Medicaid
AL051521002JUDOtherBKUE CROSS PROVIDER #