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General NPI Number Information
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NPI Number | 1144254418
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Entity Type | Individual
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Provider Name | TOM ALAN JUDY PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 10130 PERIMETER PKWY STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28216-2447
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Country | US
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Telephone | 888-849-7379
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Fax | 855-857-7333
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Provider Business Mailing Address
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Address Line | 10130 PERIMETER PKWY STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28216-2447
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Country | US
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Telephone | 888-849-7379
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Fax | 855-857-7333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015190
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50003018
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10-95
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License Number State | NC
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