Provider Demographics
NPI:1114581923
Name:HUDSON, HELEN RACHAEL GANDY (DO)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:RACHAEL GANDY
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7283
Mailing Address - Country:US
Mailing Address - Phone:601-579-5050
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:15 ORLEANS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8675
Practice Address - Country:US
Practice Address - Phone:601-579-5050
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine