MEDICARE: DR. SHANE HUDNALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	141561	NC

General Provider Information

NPI Number	:	1447453451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE HUDNALL MD

Provider Business Mailing Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:	336-832-7000
Fax Number	:	336-832-7869

Provider Business Practice Location Address
First Line	:	2630 WILLARD DAIRY RD
Second Line	:	SUITE 202
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8351
Country	:	US
Telephone Number	:	336-884-3770
Fax Number	:	336-884-3771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	12/13/2012

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