MEDICARE: JUDITH LAUREN ANDERSON NP

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	363L00000X	Nurse Practitioner	APRN-NP201550	GA
2	363LA2100X	Acute Care Nurse Practitioner	RN201550	GA
3	363LF0000X	Family Nurse Practitioner	RN201550	GA
4	363LA2100X	Acute Care Nurse Practitioner	RN2012550	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003182231A	OTHER	GA	PEACH STATE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	04229901	OTHER	GA	AMERIGROUP
4	1304001	OTHER	GA	WELLCARE
5	003182231B	OTHER	GA	PEACH STATE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356891220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH LAUREN ANDERSON NP

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	03/10/2026

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Directions to “ JUDITH LAUREN ANDERSON NP” Practice Location

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