Provider Demographics
NPI:1578751509
Name:KLUDT, JOHN RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDALL
Last Name:KLUDT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3700 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2960
Mailing Address - Country:US
Mailing Address - Phone:678-280-6630
Mailing Address - Fax:678-280-6635
Practice Address - Street 1:3700 CLUB DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2960
Practice Address - Country:US
Practice Address - Phone:678-280-6630
Practice Address - Fax:678-280-6635
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2013-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine