MEDICARE: DR. JEREMIAH W JUDKINS M.D.

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	207P00000X	Emergency Medicine Physician	MD27367	ME
2	207R00000X	Internal Medicine Physician	MD0000044395	TN
3	208M00000X	Hospitalist Physician	MD0000044395	TN
4	390200000X	Student in an Organized Health Care Education/Training Program
5	207P00000X	Emergency Medicine Physician	MD0000044395	TN

General Provider Information

NPI Number	:	1972723104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMIAH W JUDKINS M.D.

Provider Business Mailing Address
First Line	:	1069 LITCHFIELD PL
Second Line	:
City	:	GALLATIN
State	:	TN
Zip	:	37066-5611
Country	:	US
Telephone Number	:	615-772-5727
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 NEW SHACKLE ISLAND RD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2479
Country	:	US
Telephone Number	:	615-338-1000
Fax Number	:

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	10/05/2023

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