Provider Demographics
NPI:1679000376
Name:HUNDLEY, CARLOS DESHAWN (MS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:DESHAWN
Last Name:HUNDLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHARPER CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-6228
Mailing Address - Country:US
Mailing Address - Phone:229-375-9398
Mailing Address - Fax:866-484-8285
Practice Address - Street 1:8 SHARPER CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-6228
Practice Address - Country:US
Practice Address - Phone:229-375-9398
Practice Address - Fax:866-484-8285
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor