Healthcare Provider Details

I. General information

NPI: 1740221878
Provider Name (Legal Business Name): ROBERT W HUDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 MEMORIAL DR
CLARKSVILLE TN
37043-4603
US

IV. Provider business mailing address

1856 MEMORIAL DR
CLARKSVILLE TN
37043-4603
US

V. Phone/Fax

Practice location:
  • Phone: 931-552-4600
  • Fax: 931-552-7001
Mailing address:
  • Phone: 931-552-4600
  • Fax: 931-552-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0011048
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: