Provider Demographics
NPI:1366919698
Name:LEXO-HUDSON, BONNIE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:LEXO-HUDSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1786 OAK RD
Mailing Address - Street 2:STE B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2220
Mailing Address - Country:US
Mailing Address - Phone:770-925-2526
Mailing Address - Fax:770-921-1770
Practice Address - Street 1:976 KILLIAN HILL RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3102
Practice Address - Country:US
Practice Address - Phone:770-752-4142
Practice Address - Fax:877-919-4091
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA084713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily