Provider Demographics
NPI:1003181215
Name:DR. HUGH HUDSON DDS
Entity Type:Organization
Organization Name:DR. HUGH HUDSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:229-776-6431
Mailing Address - Street 1:108 WEST POPE STREET
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791
Mailing Address - Country:US
Mailing Address - Phone:229-776-6431
Mailing Address - Fax:229-776-4295
Practice Address - Street 1:108 WEST POPE STREET
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791
Practice Address - Country:US
Practice Address - Phone:229-776-6431
Practice Address - Fax:229-776-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN007189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty