Provider Demographics
NPI:1578562187
Name:HUDSON, WILLIAM MANCHESTER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MANCHESTER
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA025619207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000280134IMedicaid
GA511I060026Medicare PIN
GA000280134IMedicaid