RENEE BOUDREAUX ATC NPI 1770004715

NPI Information

  • NPI: 1770004715
  • Provider Name: RENEE BOUDREAUX, ATC
  • Classification: Podiatrist - 213ES0000X
  • Specialization: Sports Medicine
  • Entity Type: Individual
  • Address: 1501 MERCER UNIVERSITY DR
    MACON, GA
    ZIP 31207
  • Phone: (478) 301-4609

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NPI Details

Renee Boudreaux, ATC is a sports medicine podiatrist in Macon, GA. Renee Boudreaux, ATC NPI is 1770004715. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1501 MERCER UNIVERSITY DR
MACON, GA
ZIP 31207
Phone: (478) 301-4609

The enumeration date for this NPI number is 6/29/2017 and was last updated on 6/29/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0000XPodiatristSports MedicineAT003149GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1BOC317023OTHERGEORGIAATHLETIC TRAINING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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