MEDICARE: DR. GENEECO HUDSON DUKES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR007294	GA

General Provider Information

NPI Number	:	1225020050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENEECO HUDSON DUKES D.C.

Provider Business Mailing Address
First Line	:	211 STALLION TRL
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-6731
Country	:	US
Telephone Number	:	770-507-9592
Fax Number	:	770-210-2450

Provider Business Practice Location Address
First Line	:	147 NORTH PARK TRAIL
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7373
Country	:	US
Telephone Number	:	770-507-9592
Fax Number	:	770-507-8047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	08/23/2007

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