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General NPI Number Information
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NPI Number | 1982065652
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Entity Type | Individual
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Provider Name | SHRONDA LOUDER
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Gender | Female
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1 N GODLEY STATION BLVD # 12
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City | POOLER
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State | GA
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Zip | 31322-4411
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Country | US
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Telephone | 678-994-3382
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Fax | 912-299-2345
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Provider Business Mailing Address
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Address Line | 1 N GODLEY STATION BLVD
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City | POOLER
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State | GA
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Zip | 31322-4411
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Country | US
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Telephone | 678-994-3382
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Fax | 912-299-2345
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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 | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number | CO090464
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CO090464
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License Number State | GA
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