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Contact Information

JUDY SOUTHERN
1100 E WENDOVER AVE
GREENSBORO, NC27405-6713
 Phone: 336-641-3712
 Fax: 336-641-6603
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Administrator

163WA2000X
Indicates primary specialty

NPI Profile & details for JUDY SOUTHERN · (Female)

NPI # 1003118092
Status Active
Credentials
Entity Individual
Enumeration date 11/23/2010
Last updated 11/23/2010 - About 16 years ago
Sole proprietor 1 Yes
Identifiers
  • NC License # 59604
  • NC Medicaid 1245272657
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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