Individual
RENEE BOUDREAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1501 MERCER UNIVERSITY DR, MACON, GA 31207
(478) 301-4609
Mailing address
1501 MERCER UNIVERSITY DR, MACON, GA 31207-1515
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
AT003149
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BOC317023
ATHLETIC TRAINING
GA
Enumeration date
06/29/2017
Last updated
06/29/2017
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