Healthcare Provider Details

I. General information

NPI: 1295226140
Provider Name (Legal Business Name): JESSICA ARNOLD DUDDLESTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3928 MONTCLAIR RD STE 100
MOUNTAIN BRK AL
35213-2415
US

IV. Provider business mailing address

3928 MONTCLAIR RD STE 100
MOUNTAIN BRK AL
35213-2415
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-3911
  • Fax:
Mailing address:
  • Phone: 205-592-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number44247
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number238534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: