Active NPI
Robert W Hudson, M.D.
- Adult Medicine Physician
- Clarksville, TN
National Provider Identifier
1740221878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- 0011048
- Practice address
- 1856 Memorial Dr
Clarksville, TN 37043-4603 - Phone
- (931) 552-4600
- Fax
- (931) 552-7001
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 0011048 | TN | Primary |
Addresses
Primary practice location
1856 Memorial Dr
Clarksville, TN 37043-4603
Mailing address
1856 Memorial Dr
Clarksville, TN 37043-4603
Phone (931) 552-4600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q009635 | Medicaid | TN | |
| 6042970 | Other | TN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0011048 | TN | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549929600000",
"number": "1740221878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1856 MEMORIAL DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370434603",
"telephone_number": "931-552-4600",
"fax_number": "931-552-7001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1856 MEMORIAL DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370434603",
"telephone_number": "931-552-4600",
"fax_number": "931-552-7001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDSON",
"first_name": "ROBERT",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2019-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "TN",
"license": "0011048",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q009635",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "6042970",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.