Individual
JUDY SOUTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 E WENDOVER AVE, GREENSBORO, NC 27405-6713
(336) 641-3712
(336) 641-6603
Mailing address
1100 E WENDOVER AVE, GREENSBORO, NC 27405-6713
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
59604
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245272657
—
NC
Enumeration date
11/23/2010
Last updated
11/23/2010
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