Provider Demographics
NPI:1427397116
Name:HUDSON-GALLOGLY, WANDA KIM (RN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:KIM
Last Name:HUDSON-GALLOGLY
Suffix:
Gender:F
Credentials:RN, WHNP-BC
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Other - Credentials:
Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5600
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:134 ANSLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1639
Practice Address - Country:US
Practice Address - Phone:706-864-2155
Practice Address - Fax:706-374-7628
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2017-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA097026363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148051AMedicaid