Provider Demographics
NPI:1265596589
Name:HUDSON-WEIRES, ELIZABETH JEAN (MSN, APRN, ACCNS-AG)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:HUDSON-WEIRES
Suffix:
Gender:F
Credentials:MSN, APRN, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7694
Mailing Address - Country:US
Mailing Address - Phone:678-312-1691
Mailing Address - Fax:
Practice Address - Street 1:1550 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31207
Practice Address - Country:US
Practice Address - Phone:478-301-4111
Practice Address - Fax:478-301-2387
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN130087364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care