Provider Demographics
NPI:1104571868
Name:HUDSON, TEAJUANNA
Entity type:Individual
Prefix:
First Name:TEAJUANNA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CORPORATE CENTER DR STE E
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7383
Mailing Address - Country:US
Mailing Address - Phone:678-528-1147
Mailing Address - Fax:
Practice Address - Street 1:205 CORPORATE CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7383
Practice Address - Country:US
Practice Address - Phone:678-528-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care