Provider Demographics
NPI:1942233002
Name:BUDLONG, BRENDA D (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:BUDLONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:420 E 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3224
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:706-509-4608
Practice Address - Street 1:304 SHORTER AVE NW
Practice Address - Street 2:SUITE 102
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4290
Practice Address - Country:US
Practice Address - Phone:706-233-9349
Practice Address - Fax:706-232-7986
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00567421EMedicaid
GAF68414Medicare UPIN
GA08BDMLMMedicare ID - Type UnspecifiedMEDICARE