MEDICARE: DR. JESSICA ARNOLD DUDDLESTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	44247	AL
2	390200000X	Student in an Organized Health Care Education/Training Program	238534	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295226140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA ARNOLD DUDDLESTON MD

Provider Business Mailing Address
First Line	:	3928 MONTCLAIR RD STE 100
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35213-2415
Country	:	US
Telephone Number	:	205-592-3911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3928 MONTCLAIR RD STE 100
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35213-2415
Country	:	US
Telephone Number	:	205-592-3911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2018
Last Update Date	:	07/15/2022

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