Provider Demographics
NPI:1073083192
Name:HUDGINS, KORI ELISABETH (MS)
Entity Type:Individual
Prefix:MRS
First Name:KORI
Middle Name:ELISABETH
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-5235
Mailing Address - Country:US
Mailing Address - Phone:706-676-4340
Mailing Address - Fax:
Practice Address - Street 1:21 MILLIE ANN LN
Practice Address - Street 2:
Practice Address - City:OHATCHEE
Practice Address - State:AL
Practice Address - Zip Code:36271-4382
Practice Address - Country:US
Practice Address - Phone:256-624-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL183101YA0400X
101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health