Individual
MRS. JUDIE A. DUMELOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, CKTP, IMC, C/NDT
Contact information
Practice address
3351 NORTHSIDE DR, MACON, GA 31210-2587
(478) 474-4035
(478) 474-7713
Mailing address
310 ASHVILLE CT, MACON, GA 31210-1669
(478) 474-4035
(478) 474-7713
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002435
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000760702B
—
GA
05
—
193449608B
—
GA
05
—
306817636A
—
GA
05
—
537484753A
—
GA
05
—
813105927A
—
GA
Enumeration date
12/13/2006
Last updated
04/01/2014
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