Provider Demographics
NPI:1225020050
Name:DUKES, GENEECO HUDSON (DC)
Entity Type:Individual
Prefix:DR
First Name:GENEECO
Middle Name:HUDSON
Last Name:DUKES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STALLION TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-6731
Mailing Address - Country:US
Mailing Address - Phone:770-507-9592
Mailing Address - Fax:770-210-2450
Practice Address - Street 1:147 NORTH PARK TRAIL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7373
Practice Address - Country:US
Practice Address - Phone:770-507-9592
Practice Address - Fax:770-507-8047
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV04754Medicare UPIN