Provider Demographics
NPI:1316528805
Name:GRAHAM-HUDGINS, JALESSA JONELLE (MD)
Entity type:Individual
Prefix:DR
First Name:JALESSA
Middle Name:JONELLE
Last Name:GRAHAM-HUDGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GRADUATE MEDICAL EDUCATION OFFICE
Mailing Address - Street 2:185 DUNAGAN COURT
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6115 PEACHTREE DUNWOODY RD STE 350
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5699
Practice Address - Country:US
Practice Address - Phone:678-320-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100969207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine