Provider Demographics
NPI:1952348039
Name:SONG, JUDY H (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:H
Last Name:SONG
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:PO BOX 4196
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31914-0196
Mailing Address - Country:US
Mailing Address - Phone:706-653-1102
Mailing Address - Fax:706-653-1203
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:SUITE 205
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:301-279-4499
Practice Address - Fax:301-279-4489
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00579242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699111400Medicaid
MDKA80OtherB/C B/S
DC2849OtherB/C B/S
MDJ062OtherB/C B/S
MDH50412Medicare UPIN
MD435LD547Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 02
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDJ062OtherB/C B/S
DC2849OtherB/C B/S
MDKA80OtherB/C B/S
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE
DC004126D23Medicare PIN