Individual
MRS. JUDY WU DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2651 REDDING RD NE, ATLANTA, GA 30319-2963
(404) 841-5466
Mailing address
2651 REDDING RD NE, ATLANTA, GA 30319-2963
(404) 841-5466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6137
GA
363A00000X
Physician Assistant
PA02684
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87N556
BLUE CROSS
TX
01
—
970013327
RAILROAD MEDICARE
TX
Enumeration date
01/05/2007
Last updated
06/25/2012
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