Provider Demographics
NPI:1780236471
Name:HUDSON, TANDRA (CNM)
Entity type:Individual
Prefix:
First Name:TANDRA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 UPPER HEMBREE RD STE D
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0927
Mailing Address - Country:US
Mailing Address - Phone:770-670-6170
Mailing Address - Fax:770-670-6171
Practice Address - Street 1:833 CAMPBELL HILL ST NW STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1147
Practice Address - Country:US
Practice Address - Phone:770-528-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165619207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics