MEDICARE: JUDY MARIE NO RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LDN2738	TN

General Provider Information

NPI Number	:	1033511381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY MARIE NO RD

Provider Business Mailing Address
First Line	:	300 EAST HOSPITAL ROAD
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-9998
Country	:	US
Telephone Number	:	706-787-5915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 GEORGETOWN RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3562
Country	:	US
Telephone Number	:	423-339-1415
Fax Number	:	423-339-1715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	03/21/2024

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