Provider Demographics
NPI:1720376833
Name:CUDGER, ANGELA (PA-A, HEALTH COACH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:CUDGER
Suffix:
Gender:F
Credentials:PA-A, HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7778 MCGINNIS FERRY ROAD
Mailing Address - Street 2:PMB 303
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2564
Mailing Address - Country:US
Mailing Address - Phone:404-388-7235
Mailing Address - Fax:
Practice Address - Street 1:6820 VICTORY RUN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3002
Practice Address - Country:US
Practice Address - Phone:404-388-7235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1255367H00000X
GA6865367H00000X
GA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135897AMedicaid
GA003135897CMedicaid
GA003135897BMedicaid
GA003135897DMedicaid
GA01869603OtherAMERIGROUP
GA003135897CMedicaid