MEDICARE: DR. MARK C HUDSON D.O.

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	207Q00000X	Family Medicine Physician	038807	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DE0736	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	336122	OTHER	GA	WELLCARE
3	800790	OTHER	GA	BLUE SHIELD
4	000624599D	OTHER	GA	PEACH STATE HEALTH PLAN

General Provider Information

NPI Number	:	1437112497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK C HUDSON D.O.

Provider Business Mailing Address
First Line	:	1 DOCTORS PARK
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3072
Country	:	US
Telephone Number	:	229-378-8110
Fax Number	:	229-378-8109

Provider Business Practice Location Address
First Line	:	1 DOCTORS PARK
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3072
Country	:	US
Telephone Number	:	229-378-8110
Fax Number	:	229-378-8109

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/23/2010

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Directions to “ DR. MARK C HUDSON D.O.” Practice Location

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