Provider Demographics
NPI:1457960676
Name:HUDGINS, STEVEN R (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:HUDGINS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 OGLETHORPE AVE NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3312
Mailing Address - Country:US
Mailing Address - Phone:404-513-9852
Mailing Address - Fax:
Practice Address - Street 1:1202 OGLETHORPE AVE NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3312
Practice Address - Country:US
Practice Address - Phone:404-513-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty