Provider Demographics
NPI:1922368216
Name:HUBBARD, TAJ YUSEF
Entity Type:Individual
Prefix:MR
First Name:TAJ
Middle Name:YUSEF
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12430 DOWNY BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3675
Mailing Address - Country:US
Mailing Address - Phone:704-606-5013
Mailing Address - Fax:
Practice Address - Street 1:12430 DOWNY BIRCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3675
Practice Address - Country:US
Practice Address - Phone:704-606-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No172A00000XOther Service ProvidersDriver
No173000000XOther Service ProvidersLegal Medicine
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant