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Individual

MRS. KORIE L AGUDELO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
380 HOSPITAL DR, SUITE 410, MACON, GA 31217
(478) 746-5644
Mailing address
PO BOX 2564, MACON, GA 31203-2565
(478) 746-5644
(478) 745-4849

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN159841
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003113553I
GA
05
003113553J
GA
05
003116613A
GA
05
003116613C
GA
01
580628385
TRICARE
GA
01
637585
WELLCARE
GA
Enumeration date
03/25/2011
Last updated
06/04/2013
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