Provider Demographics
NPI:1730162470
Name:HOFFMAN, JUDY LYNN (NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 DAVIS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4612
Mailing Address - Country:US
Mailing Address - Phone:706-647-7875
Mailing Address - Fax:
Practice Address - Street 1:1512 HIGHWAY 19 N
Practice Address - Street 2:FAMILY MEDICAL CENTER
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-2258
Practice Address - Country:US
Practice Address - Phone:706-647-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715359363LF0000X
GARN169860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179449701Medicaid
GA616059616Medicaid
TX8N9920OtherBCBS OF TX
TX179449704OtherCIDC
TX8G5625Medicare PIN
TX179449704OtherCIDC
GA202I503918Medicare Oscar/Certification