Healthcare Provider Details

I. General information

NPI: 1689764896
Provider Name (Legal Business Name): HENRY J. HUDSON AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CHAMBLEE TUCKER RD
CHAMBLEE GA
30341-4418
US

IV. Provider business mailing address

3640 CHAMBLEE TUCKER RD
CHAMBLEE GA
30341-4418
US

V. Phone/Fax

Practice location:
  • Phone: 770-938-0232
  • Fax:
Mailing address:
  • Phone: 770-938-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARILYN A. CLOW
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-938-0232