Individual
SHRONDA LOUDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 N GODLEY STATION BLVD # 12, POOLER, GA 31322-4411
(678) 994-3382
(912) 299-2345
Mailing address
1 N GODLEY STATION BLVD, POOLER, GA 31322-4411
(678) 994-3382
(912) 299-2345
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO090464
GA
224900000X
Mastectomy Fitter
CO090464
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134277356
ANCILLARY
GA
Enumeration date
03/09/2016
Last updated
11/06/2025
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