Individual
REBECCA DUDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
804 MYRTLE ST, VALDOSTA, GA 31601-4831
(229) 563-9721
Mailing address
804 MYRTLE ST, VALDOSTA, GA 31601-4831
(229) 563-9721
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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