Provider Demographics
NPI:1366945404
Name:HUDSON-NEELEY, LUCINDA MILES
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:MILES
Last Name:HUDSON-NEELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCI
Other - Middle Name:MILES
Other - Last Name:HUDSON-NEELEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1355 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4433
Practice Address - Country:US
Practice Address - Phone:678-664-3293
Practice Address - Fax:678-664-3294
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily