MEDICARE: TERESA JUDY, PC

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	302F00000X	Exclusive Provider Organization	C2667A	AL
2	302F00000X	Exclusive Provider Organization	3802	AL

General Provider Information

NPI Number	:	1750813572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA JUDY, PC

Provider Business Mailing Address
First Line	:	810 REGAL DR SW STE D
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5649
Country	:	US
Telephone Number	:	256-715-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 REGAL DR SW STE D
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5649
Country	:	US
Telephone Number	:	256-715-9800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA L WILLIAMS
Credential	:	LPC
Telephone Number	:	256-503-3888

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	08/31/2021

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Directions to “TERESA JUDY, PC ” Practice Location

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