Provider Demographics
NPI:1558859496
Name:HUDSPETH, THOMAS LAWRENCE JR
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:HUDSPETH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 MIZE FARM CT
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-7530
Mailing Address - Country:US
Mailing Address - Phone:865-983-6490
Mailing Address - Fax:
Practice Address - Street 1:1030 HUNTERS XING
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1849
Practice Address - Country:US
Practice Address - Phone:865-984-2671
Practice Address - Fax:865-984-2875
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist