Provider Demographics
NPI:1447448626
Name:WILLIAM M. HUDSON, MD, PC
Entity type:Organization
Organization Name:WILLIAM M. HUDSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-887-0472
Mailing Address - Street 1:110 SAMARITAN DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2535
Mailing Address - Country:US
Mailing Address - Phone:770-887-0472
Mailing Address - Fax:770-887-1140
Practice Address - Street 1:110 SAMARITAN DR
Practice Address - Street 2:STE 101
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2535
Practice Address - Country:US
Practice Address - Phone:770-887-0472
Practice Address - Fax:770-887-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025619207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40201Medicare UPIN