Provider Demographics
NPI:1598773889
Name:HUDSON, JALILA (MD)
Entity Type:Individual
Prefix:DR
First Name:JALILA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JALILA
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:610 PATRIOT LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5772
Mailing Address - Country:US
Mailing Address - Phone:423-595-3724
Mailing Address - Fax:
Practice Address - Street 1:610 PATRIOT LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5772
Practice Address - Country:US
Practice Address - Phone:423-595-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37272207R00000X, 208M00000X
IAMD44712208M00000X
NE30327208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3891297Medicaid
TN3891297Medicaid
TN3891298Medicare PIN
TN3891296Medicare PIN
TN3891297Medicare PIN