Healthcare Provider Details

I. General information

NPI: 1831536945
Provider Name (Legal Business Name): JUDY LEDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S LEE HWY
CLEVELAND TN
37311-5858
US

IV. Provider business mailing address

1011 S LEE HWY
CLEVELAND TN
37311-5858
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-6249
  • Fax: 423-559-0195
Mailing address:
  • Phone: 423-476-6249
  • Fax: 423-559-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number58144240
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number058144240
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: