Provider Demographics
NPI:1659822435
Name:HUDES CONCIERGE MEDICINE, LLC
Entity Type:Organization
Organization Name:HUDES CONCIERGE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HUDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-656-7381
Mailing Address - Street 1:5400 LAUREL SPRINGS PKWY
Mailing Address - Street 2:BLDG 1400, SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6056
Mailing Address - Country:US
Mailing Address - Phone:770-656-7381
Mailing Address - Fax:470-253-7126
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:BLDG 1400, SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:770-656-7381
Practice Address - Fax:470-253-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF10526Medicare UPIN