Provider Demographics
NPI:1063488088
Name:HUDES, BRIAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:HUDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 DAHLONEGA STREET
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5121
Mailing Address - Country:US
Mailing Address - Phone:678-935-0655
Mailing Address - Fax:678-456-8176
Practice Address - Street 1:416 DAHLONEGA STREET
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3004
Practice Address - Country:US
Practice Address - Phone:678-935-0655
Practice Address - Fax:678-456-8176
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042852174400000X, 207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00731145CMedicaid
GA10BBCFXMedicare ID - Type Unspecified
GA00731145CMedicaid