Provider Demographics
NPI:1679050223
Name:HUDSON, THOMAS NEIL (FNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:NEIL
Last Name:HUDSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CIRCLE J DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1981
Mailing Address - Country:US
Mailing Address - Phone:601-425-0092
Mailing Address - Fax:601-425-0473
Practice Address - Street 1:30 CIRCLE J DR STE 1
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440
Practice Address - Country:US
Practice Address - Phone:601-425-0092
Practice Address - Fax:601-425-0473
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine