MEDICARE: MR. DAVID VAN HUDSON III FNP

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	RN300900	GA

General Provider Information

NPI Number	:	1750213294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID VAN HUDSON III FNP

Provider Business Mailing Address
First Line	:	4253 LAKEVIEW ST
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-5414
Country	:	US
Telephone Number	:	423-645-6554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4253 LAKEVIEW ST
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-5414
Country	:	US
Telephone Number	:	423-645-6554
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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