Healthcare Provider Details

I. General information

NPI: 1851019574
Provider Name (Legal Business Name): JEFF JUDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 1/2 GREENSBORO AVE
TUSCALOOSA AL
35401-1844
US

IV. Provider business mailing address

714 1/2 GREENSBORO AVE
TUSCALOOSA AL
35401-1844
US

V. Phone/Fax

Practice location:
  • Phone: 205-464-8600
  • Fax:
Mailing address:
  • Phone: 205-464-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number1035
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: