Healthcare Provider Details

I. General information

NPI: 1679063846
Provider Name (Legal Business Name): WILLIAM MANCHESTER HUDSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

877 JEFFERON AVE
MEMPHIS TN
38103
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4411
  • Fax:
Mailing address:
  • Phone: 901-448-7635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number73731
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: