Provider Demographics
NPI:1982065652
Name:LOUDER, SHRONDA
Entity type:Individual
Prefix:
First Name:SHRONDA
Middle Name:
Last Name:LOUDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N GODLEY STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4411
Mailing Address - Country:US
Mailing Address - Phone:678-994-3382
Mailing Address - Fax:912-299-2345
Practice Address - Street 1:1 N GODLEY STATION BLVD # 12
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4411
Practice Address - Country:US
Practice Address - Phone:678-994-3382
Practice Address - Fax:912-299-2345
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO090464224900000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA134277356OtherANCILLARY