Provider Demographics
NPI:1154376416
Name:HUDSON, NOLAN LEONARD (MD)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:LEONARD
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 DECATUR HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2301
Mailing Address - Country:US
Mailing Address - Phone:205-418-1200
Mailing Address - Fax:205-418-1210
Practice Address - Street 1:2217 DECATUR HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2301
Practice Address - Country:US
Practice Address - Phone:205-418-1200
Practice Address - Fax:205-418-1210
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051530595Medicaid
AL0410307OtherUNITED HEALTHCARE
ALP00255709OtherRAILROAD MEDICARE
AL051530595OtherBLUE CROSS & BLUE SHIELD
ALP00255709OtherRAILROAD MEDICARE
AL051530595Medicare ID - Type Unspecified
AL051530595Medicaid