Provider Demographics
NPI:1275553448
Name:HUDSON, TONYA M (MD)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16740 DAVIDSON CONCORD RD
Practice Address - Street 2:STE 200
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8746
Practice Address - Country:US
Practice Address - Phone:704-444-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401214208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275553448Medicaid
NC8944496Medicaid
SCQ0121VMedicaid
NC44496OtherNCBCBS
NC8944496Medicaid
NC2210708FMedicare PIN
SCQ0121VMedicaid
NC1275553448Medicaid
NC2210708EMedicare PIN
NC2210708CMedicare PIN
080165626Medicare PIN
NCNCL940BMedicare PIN