RENEE BOUDREAUX (NPI# 1770004715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770004715 |
| Entity Type | Individual |
| Full Name | RENEE BOUDREAUX |
| Credential | ATC |
| Practice Address |
1501 Mercer University Dr Macon GA 31207 |
| Mailing Address |
1501 Mercer University Dr Macon GA 31207-1515 |
| Practice Telephone | 4783014609 |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2017-06-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0000X |
Podiatrist Specialization: Sports Medicine |
AT003149 | GA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | ATHLETIC TRAINING | BOC317023 | 01 |
| Street Address |
1501 MERCER UNIVERSITY DR |
| City | MACON |
| State | GA |
| Zip Code | 31207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902254766 | Matthew Mackenzie Kahrmann | Student in an Organized Health Care Education/Training Program | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2016-06-01 |
| 1609494343 | Nicole Sibert | Specialist/Technologist | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2020-07-09 |
| 1427676162 | Jessica Leanne Waters | Specialist/Technologist | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2020-07-09 |
| 1598383234 | Hollye Robinson | Specialist/Technologist | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2020-07-09 |
| 1023634409 | Clayton Seigel | Student in an Organized Health Care Education/Training Program | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2020-06-22 |
| 1609403559 | Bryan John Hostetler | Student in an Organized Health Care Education/Training Program | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2020-03-23 |
| 1326697988 | Ayana Nikita Graham | Student in an Organized Health Care Education/Training Program | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2019-09-06 |
| 1861976367 | Indya Denise Brown | Emergency Medicine | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2018-09-20 |
| 1962982124 | Emily Hartley Gabriel | Specialist/Technologist | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2018-08-17 |
| 1336654326 | Edward Larry Long IIi | Student in an Organized Health Care Education/Training Program | 1501 Mercer University Dr, Macon, GA 31207-1515 | 2017-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316296627 | Jonathan Gustav Bulla | Student in an Organized Health Care Education/Training Program | 1550 College Street, Macon, GA 31207 | 2012-08-31 |
| 1366723751 | Abigail Lewis | Family Medicine | 1550 College St, Macon, GA 31207 | 2011-08-30 |
| 1265596589 | Elizabeth Jean Hudson-weires | Registered Nurse | 1550 College Street, Macon, GA 31207 | 2006-12-21 |
| 1316593262 | Nicole Theresia Mette | Student in an Organized Health Care Education/Training Program | 1550 College St Mercer University School of Medicine, Macon, GA 31207-0001 | 2019-08-16 |
| 1558921973 | Anna Nielsen Walker | Pathology | Mercer University School of Medicine Dept of Pathology, Macon, GA 31207-0001 | 2019-06-18 |
| 1770057788 | Brian Daniel Wright | Student in an Organized Health Care Education/Training Program | 1550 College Steeet, Macon, GA 31207-0001 | 2019-01-14 |
| 1710481049 | Sarah Nicole Telliard | Student in an Organized Health Care Education/Training Program | Mercer University School of Medicine 1550 College St, Macon, GA 31207-0001 | 2018-03-21 |
| 1174925416 | William Holcomb | Specialist/Technologist | 1501 Mercer University Drive Mercer University, Macon, GA 31207-0001 | 2014-09-18 |
| 1760665913 | Daniel John Gibbs | Specialist/Technologist | University Athletics, 1400 Coleman Ave, Macon, GA 31207-0001 | 2007-12-11 |
| 1285747642 | Kristin Elizabeth Bourque | Specialist/Technologist | 1400 Coleman Ave, Mercer University Athletic Department, Macon, GA 31207-0001 | 2006-08-17 |
| Find all providers in zip 31207 | ||||
| Taxonomy Code | 213ES0000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Sports Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376529479 | Perry Howard Julien | Podiatrist | 5600 Roswell Rd Ne, Suite M-190, Atlanta, GA 30342-1150 | 2005-12-20 |
| 1437186012 | Edward Francis Szabo | Podiatrist | 1120 15th Street, Augusta, GA 30912-0004 | 2006-06-27 |
| 1184684862 | Charles Fink Peebles | Podiatrist | 5600 Roswell Rd Ne, Suite M-190, Atlanta, GA 30342-1150 | 2006-03-25 |
Please comment or provide details below to improve the information on RENEE BOUDREAUX.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.