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General NPI Number Information
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NPI Number | 1922125285
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Entity Type | Organization
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Legal Business Name | HUDES ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 4275 JOHNS CREEK PKWY SUITE A
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City | SUWANEE
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State | GA
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Zip | 30024-6038
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Country | US
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Telephone | 678-475-1606
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Fax |
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Provider Business Mailing Address
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Address Line | 4275 JOHNS CREEK PKWY SUITE A
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City | SUWANEE
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State | GA
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Zip | 30024-6038
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Country | US
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Telephone | 678-475-1606
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANA BAKER
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Credential |
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Telephone | 404-888-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 058-318
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License Number State | GA
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