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General NPI Number Information
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NPI Number | 1417163916
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Entity Type | Individual
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Provider Name | KELLY K HUDSON FNP
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 239 IVAN ALLEN JR. BOULEVARD
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City | ATLANTA
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State | GA
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Zip | 30313
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Country | US
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Telephone | 404-523-6571
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Fax | 404-523-6574
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Provider Business Mailing Address
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Address Line | 440 SUMMERFIELD DRIVE
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City | ALPHARETTA
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State | GA
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Zip | 30022
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Country | US
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Telephone | 770-740-1267
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Fax | 404-523-6574
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R093576
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License Number State | GA
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