Provider Demographics
NPI:1700863438
Name:HUDSON, JOHN KENNISON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNISON
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3696 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-736-1830
Mailing Address - Fax:706-737-5103
Practice Address - Street 1:3696 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6520
Practice Address - Country:US
Practice Address - Phone:706-736-1830
Practice Address - Fax:706-737-5103
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2025-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA041582207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3600044OtherUNITED HEALTHCARE
GA00723874Medicaid
SCG41582Medicaid
GA2126300OtherAETNA
GAP00035369OtherRAILROAD MEDICARE
GA717228OtherBLUE CROSS BLUE SHIELD
GAP00035369OtherRAILROAD MEDICARE
GA3600044OtherUNITED HEALTHCARE