Provider Demographics
NPI:1912974429
Name:HUDSON, YACOBA (MD)
Entity Type:Individual
Prefix:DR
First Name:YACOBA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YACOBA
Other - Middle Name:
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102321
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2321
Mailing Address - Country:US
Mailing Address - Phone:770-801-2500
Mailing Address - Fax:
Practice Address - Street 1:9766 HIGHWAY 92
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6455
Practice Address - Country:US
Practice Address - Phone:770-926-8717
Practice Address - Fax:770-916-4820
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1912974429OtherNPI NUMBER