| Doctor Name: | JUDY SOUTHERN |
| NPI Number: | 1003118092 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 59604 |
| Business Practice Address: | 1100 E Wendover Ave Greensboro, NC - 274056713 |
| Business Phone Number: | 3366413712 |
| Business Fax Number: | 3366416603 |
| Mailing Address: | 1100 E Wendover Ave, GREENSBORO |
| State: | NC |
| Postal Code: | 274056713 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/23/2010 |
| NPI Last Update Date: | 11/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA2000X |
| License Number: | 59604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Administrator |
| Taxonomy Definition: | |