Provider Demographics
NPI:1255432258
Name:HUTSON, JOHN ROBERT (PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:HUTSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 APPLEING CARE LANE
Mailing Address - Street 2:100
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:901-388-1893
Mailing Address - Fax:901-388-1995
Practice Address - Street 1:1540 APPLEING CARE LANE
Practice Address - Street 2:100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016
Practice Address - Country:US
Practice Address - Phone:901-388-1893
Practice Address - Fax:901-388-1995
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680436Medicare ID - Type Unspecified