Healthcare Provider Details

I. General information

NPI: 1437112497
Provider Name (Legal Business Name): MARK C HUDSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DOCTORS PARK
CAIRO GA
39828-3072
US

IV. Provider business mailing address

1 DOCTORS PARK
CAIRO GA
39828-3072
US

V. Phone/Fax

Practice location:
  • Phone: 229-378-8110
  • Fax: 229-378-8109
Mailing address:
  • Phone: 229-378-8110
  • Fax: 229-378-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number038807
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: