Healthcare Provider Details

I. General information

NPI: 1154043388
Provider Name (Legal Business Name): KALEY FOUST HUDSON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 4100
AUGUSTA GA
30901-5107
US

IV. Provider business mailing address

2122 SYLVAN LAKE DR
GROVETOWN GA
30813-5852
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-1381
  • Fax: 706-823-6871
Mailing address:
  • Phone: 404-983-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: