Individual provider Active NPI

Theresa Marjorie Hudson, MD

  • Family Medicine Physician
  • Newnan, GA
National Provider Identifier
1790839983
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
147556 Issued in CA
Practice address
2700 Highway 34 E
BLDG 300
Newnan, GA 30265-2315
Phone
(770) 304-0987
Fax
(770) 251-0938
NPI assigned
Jan 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 039594 GA
Family Medicine Physician 207Q00000X 147556 CA Primary

Addresses

Primary practice location

2700 Highway 34 E
BLDG 300
Newnan, GA 30265-2315

Mailing address

2700 Highway 34 E
BLDG 300
Newnan, GA 30265-2315
Phone (770) 304-0987

Other practice location 1

Corner of Route N12 and N7
Fort Defiance, AZ 86504-0649
Phone (928) 729-8000

Other identifiers 1

IdentifierTypeStateIssuer
000708045CMedicaidGA

Other names 1

  • Dr. Theresa Perry Hudson Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080218000057 GA Practitioner - Family Practice 4688757453 Reassigns benefits to 1 organization
I20250423000175 TX Practitioner - Family Practice 4688757453 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
147556CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Family Medicine CurrentSince Jan 2, 2018 Accepting new patients
The Fort Defiance Indian Hospital Board, Incorporation CurrentSince Apr 21, 2025 Accepting new patients
Piedmont Providers LLC Past Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

6875 Douglas Blvd
Ste A
Douglasville, GA 30135
Phone (404) 379-6148

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1790839983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 HIGHWAY 34 E",
            "address_2": "BLDG 300",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652315",
            "telephone_number": "770-304-0987",
            "fax_number": "770-251-0938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 HIGHWAY 34 E",
            "address_2": "BLDG 300",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652315",
            "telephone_number": "770-304-0987",
            "fax_number": "770-251-0938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Corner of Route N12 and N7",
            "address_purpose": "LOCATION",
            "city": "Fort Defiance",
            "state": "AZ",
            "postal_code": "865040649",
            "country_code": "US",
            "telephone_number": "928-729-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "THERESA",
        "middle_name": "MARJORIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "039594",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "147556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000708045C",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6875 Douglas Blvd Ste A",
            "city": "Douglasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301357155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "HUDSON",
            "middle_name": "PERRY",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newnan, GA

Sources for this page

Verify at the official NPI Registry.