Organization
GATEWAY MEDICAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP H JUDD III CPA (CPA)
(931) 905-0520
Entity
Organization
Contact information
Practice address
751 CHESAPEAKE LANE, STE 101, CLARKSVILLE, TN 37040-5263
(931) 648-0202
(931) 648-0252
Mailing address
PO BOX 3540, CLARKSVILLE, TN 37043-3540
(931) 648-0202
(931) 648-0252
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO1235
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3144330
BLUE CROSS & BLUE SHIELD
TN
05
—
3305160
—
TN
Enumeration date
03/20/2007
Last updated
06/19/2015
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