Provider Demographics
NPI:1760532899
Name:KHUDSONANDCBARBERDMDPC
Entity Type:Organization
Organization Name:KHUDSONANDCBARBERDMDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-461-9935
Mailing Address - Street 1:100 HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1849
Mailing Address - Country:US
Mailing Address - Phone:770-461-9935
Mailing Address - Fax:770-461-3871
Practice Address - Street 1:100 HOWARD LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1849
Practice Address - Country:US
Practice Address - Phone:770-461-9935
Practice Address - Fax:770-461-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty