MEDICARE: KERRI JO HUDSON AU.D.

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	237600000X	Audiologist-Hearing Aid Fitter	AUD003901	GA
2	237600000X	Audiologist-Hearing Aid Fitter	23002229A	IN

General Provider Information

NPI Number	:	1841602372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI JO HUDSON AU.D.

Provider Business Mailing Address
First Line	:	410 SW US HIGHWAY 80
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-2541
Country	:	US
Telephone Number	:	912-748-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 SW US HIGHWAY 80
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-2541
Country	:	US
Telephone Number	:	912-748-9494
Fax Number	:

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

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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