Provider Demographics
NPI:1114191020
Name:NEWTON-HUDSON, PAMELA DENISE
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:DENISE
Last Name:NEWTON-HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:DENISE
Other - Last Name:NEWTON-HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2425 TRAVIS RD
Mailing Address - Street 2:2425 TRAVIS ROAD
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-5909
Mailing Address - Country:US
Mailing Address - Phone:706-796-8211
Mailing Address - Fax:
Practice Address - Street 1:300 BLDG
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA164W00000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse