Provider Demographics
NPI:1184694069
Name:HUDSON, JOY DINA (MD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:DINA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:ELLEN
Other - Last Name:DINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:410 LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5238
Mailing Address - Country:US
Mailing Address - Phone:864-908-7406
Mailing Address - Fax:
Practice Address - Street 1:9098 FAIRFOREST RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1134
Practice Address - Country:US
Practice Address - Phone:864-342-7070
Practice Address - Fax:864-586-4327
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC197824Medicaid
SC88022OtherMEDCOST
SC5005636OtherAETNA
NC89063MXMedicaid
SC080154945Medicare PIN
SCG93844Medicare UPIN
SC197824Medicaid
SCG938446067Medicare PIN