Basic Information
| Provider Information | |||||||||
| NPI: | 1770548984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | HUDSON | ||||||||
| MiddleName: | JACKSON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 HOSPITAL DR STE A | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310212560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782723525 | ||||||||
| FaxNumber: | 4782723504 | ||||||||
| Practice Location | |||||||||
| Address1: | 206A HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310212989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782723525 | ||||||||
| FaxNumber: | 4782723504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000148 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.