Provider Demographics
NPI:1134600075
Name:ABERNATHY, JUDAH DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUDAH
Middle Name:DAVID
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ELDRICK LN
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8334
Mailing Address - Country:US
Mailing Address - Phone:865-230-5352
Mailing Address - Fax:
Practice Address - Street 1:2505 WINDSOR SPRING RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4642
Practice Address - Country:US
Practice Address - Phone:706-796-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist