Provider Demographics
NPI:1932195559
Name:JUDY, CARRIE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANNE
Last Name:JUDY
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 1:325 BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-746-7445
Practice Address - Street 1:308 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1977
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:803-774-5400
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007282207Q00000X
SC33283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC332839Medicaid