Jacquelyn Hudak Brantly, MMSC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

006743 Issued in GA

Practice address

235 Peachtree St NE
North Tower, Suite 2100
Atlanta, GA 30303-1401

Phone

(770) 994-9326

NPI assigned

Mar 11, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jacquelyn Nicole Hudak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Choa Multispecialty, LLC

  • Pediatrics Physician
  • Brookhaven, GA
  • NPI 1437493467
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362960000000",
    "number": "1720329154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3112 ALSTON DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300323301",
            "telephone_number": "770-833-8386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 PEACHTREE ST NE",
            "address_2": "NORTH TOWER, SUITE 2100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303031401",
            "telephone_number": "770-994-9326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANTLY",
        "first_name": "JACQUELYN",
        "middle_name": "HUDAK",
        "credential": "MMSC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-11",
        "last_updated": "2013-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "HUDAK",
            "middle_name": "NICOLE",
            "credential": "MMSC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bernard M Branson, MD
• Chantale Branson, MD
• Nicholson Eugene Brant, MD
• Antarnisear Brantley
• Morgane Brantley
• Ravinder Kaur Brar, MPH, M.D.
• Tripti Kaur Brar, MBBS,MS
• Caitlyn Diana Braschi, MD
• Colleen Brass
• Sierra Brassell

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.