Provider Demographics
NPI:1831536945
Name:LEDFORD, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:LEDFORD
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 1:1011 S LEE HWY
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5858
Mailing Address - Country:US
Mailing Address - Phone:423-476-6249
Mailing Address - Fax:423-559-0195
Practice Address - Street 1:1011 S LEE HWY
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5858
Practice Address - Country:US
Practice Address - Phone:423-476-6249
Practice Address - Fax:423-559-0195
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58144240171WV0202X
TN058144240172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
No172A00000XOther Service ProvidersDriver