Provider Demographics
NPI:1245319441
Name:HUDSON, LORI A (RN-FNPC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RN-FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E CHEROKEE CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1964
Mailing Address - Country:US
Mailing Address - Phone:678-761-9479
Mailing Address - Fax:
Practice Address - Street 1:510 E CHEROKEE CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-1964
Practice Address - Country:US
Practice Address - Phone:678-761-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101917-NP363LF0000X
GARN101917363LF0000X, 363L00000X
GA28818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000805153CMedicaid
GA1346893799OtherGROUP NPI
GA003224897AMedicaid
GA2379OtherGROUP MEDICARE
GA000805153DMedicaid
GA08337445OtherAMERIGROUP
GAG18382279OtherMEDICARE