Provider Demographics
NPI:1427811587
Name:HUDSON, GRANT (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-0047
Mailing Address - Country:US
Mailing Address - Phone:770-366-3606
Mailing Address - Fax:
Practice Address - Street 1:351 E HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4544
Practice Address - Country:US
Practice Address - Phone:770-366-3606
Practice Address - Fax:706-632-2723
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR011128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty