Healthcare Provider Details

I. General information

NPI: 1750213294
Provider Name (Legal Business Name): DAVID VAN HUDSON III FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TREY HUDSON FNP

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 LAKEVIEW ST
ACWORTH GA
30101-5414
US

IV. Provider business mailing address

4253 LAKEVIEW ST
ACWORTH GA
30101-5414
US

V. Phone/Fax

Practice location:
  • Phone: 423-645-6554
  • Fax:
Mailing address:
  • Phone: 423-645-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN300900
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: