Provider Demographics
NPI:1942271770
Name:ATKINS, AUDREY HUDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:HUDSON
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:LYNN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4204 WATERFORD CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2151
Mailing Address - Country:US
Mailing Address - Phone:703-599-2534
Mailing Address - Fax:
Practice Address - Street 1:343 FRANKLIN RD STE 210
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5250
Practice Address - Country:US
Practice Address - Phone:615-373-2248
Practice Address - Fax:615-373-5116
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012363312080A0000X
TN43911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010091063Medicaid
TN1507923Medicaid
TN1507923Medicaid