1134600075 NPI number — DR. JUDAH DAVID ABERNATHY PHARMD

Table of content: DR. JUDAH DAVID ABERNATHY PHARMD (NPI 1134600075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134600075 NPI number — DR. JUDAH DAVID ABERNATHY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABERNATHY
Provider First Name:
JUDAH
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134600075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 ELDRICK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVETOWN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30813-8334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-230-5352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2505 WINDSOR SPRING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30906-4642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-796-8146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH030859 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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