MEDICARE: JUDY MARLENA PAGE NP

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	207Q00000X	Family Medicine Physician	RN223429	GA

General Provider Information

NPI Number	:	1871268797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY MARLENA PAGE NP

Provider Business Mailing Address
First Line	:	5241 GUM CREEK CT
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9205
Country	:	US
Telephone Number	:	404-456-3847
Fax Number	:

Provider Business Practice Location Address
First Line	:	4186 MILL ST NE
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2559
Country	:	US
Telephone Number	:	678-625-8317
Fax Number	:

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

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	08/12/2021

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