Provider Demographics
NPI:1396225744
Name:HUDSON, LATOYA M (OWNER)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-2603
Mailing Address - Country:US
Mailing Address - Phone:662-820-7244
Mailing Address - Fax:
Practice Address - Street 1:529 CARTER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-2603
Practice Address - Country:US
Practice Address - Phone:662-820-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle