Provider Demographics
NPI:1013691815
Name:RUDOLPH-MEADOWS, RONESHIA MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:RONESHIA
Middle Name:MICHELLE
Last Name:RUDOLPH-MEADOWS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 TOWNSEND BND
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7989
Mailing Address - Country:US
Mailing Address - Phone:334-312-6250
Mailing Address - Fax:
Practice Address - Street 1:5674 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3254
Practice Address - Country:US
Practice Address - Phone:770-322-6161
Practice Address - Fax:770-322-6191
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001573363LF0000X
ALF03230027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty