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General NPI Number Information
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NPI Number | 1760532899
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Entity Type | Organization
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Legal Business Name | KHUDSONANDCBARBERDMDPC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 100 HOWARD LN
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-1849
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Country | US
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Telephone | 770-461-9935
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Fax | 770-461-3871
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Provider Business Mailing Address
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Address Line | 100 HOWARD LN
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-1849
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Country | US
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Telephone | 770-461-9935
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Fax | 770-461-3871
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Authorized Official
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Title or Position | DENTIST
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Name | WALTER KENNETH HUDSON
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Credential | DMD
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Telephone | 770-461-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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