MEDICARE: DR. VERONICA L SUDEKUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081H0002X	Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician	8841	GA
2	207R00000X	Internal Medicine Physician	263324	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295117653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERONICA L SUDEKUM MD

Provider Business Mailing Address
First Line	:	PO BOX 749495
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9495
Country	:	US
Telephone Number	:	855-963-2100
Fax Number	:	813-321-1296

Provider Business Practice Location Address
First Line	:	114 SUTHERLIN DR # C-1
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2259
Country	:	US
Telephone Number	:	478-287-6144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	09/02/2025

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