Provider Demographics
NPI:1770548984
Name:OWEN, HUDSON JACKSON JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:HUDSON
Middle Name:JACKSON
Last Name:OWEN
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:206 HOSPITAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2560
Mailing Address - Country:US
Mailing Address - Phone:478-272-3525
Mailing Address - Fax:478-272-3504
Practice Address - Street 1:206A HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2989
Practice Address - Country:US
Practice Address - Phone:478-272-3525
Practice Address - Fax:478-272-3504
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-06-05
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Provider Licenses
StateLicense IDTaxonomies
GA000148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP18504Medicare UPIN