Healthcare Provider Details

I. General information

NPI: 1871418186
Provider Name (Legal Business Name): JUDSON A MARTIN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 10TH ST
ANNISTON AL
36207-4716
US

IV. Provider business mailing address

2047 OLD ROCKY RIDGE RD
JACKSONVILLE AL
36265-7660
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-171473
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: