Provider Demographics
NPI:1669490736
Name:HUDSON, JIM KYLE III (MD)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:KYLE
Last Name:HUDSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6029 WALNUT GROVE RD STE 403
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-261-7836
Practice Address - Fax:901-226-0215
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS09724207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT08483AOtherMEDICARE
MS793967OtherMEDICARE
MS00123456Medicaid
TN1522223Medicaid