Healthcare Provider Details

I. General information

NPI: 1881620532
Provider Name (Legal Business Name): JUDITH GAY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 PINE ST
MACON GA
31201-2109
US

IV. Provider business mailing address

2490 RIVERSIDE DR STE B
MACON GA
31204-1787
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-7600
  • Fax: 478-633-7354
Mailing address:
  • Phone: 478-633-6633
  • Fax: 478-633-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN039869
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: