Provider Demographics
NPI:1689306383
Name:HUTSON, GREGORY ALLEN JR
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:HUTSON
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 37TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1150
Mailing Address - Country:US
Mailing Address - Phone:304-506-4620
Mailing Address - Fax:
Practice Address - Street 1:1115 37TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1150
Practice Address - Country:US
Practice Address - Phone:304-506-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant