Provider Demographics
NPI:1407061377
Name:FLUELLEN, JUDITH H (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:H
Last Name:FLUELLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TERRELL DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3726
Mailing Address - Country:US
Mailing Address - Phone:770-386-3745
Mailing Address - Fax:770-386-3745
Practice Address - Street 1:401 TERRELL DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3726
Practice Address - Country:US
Practice Address - Phone:770-386-3745
Practice Address - Fax:770-386-3745
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029326207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BDHTDMedicare ID - Type Unspecified
GAC34333Medicare UPIN