Provider Demographics
NPI:1841951159
Name:HUDSON, FREDDIE LEE JR
Entity type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:LEE
Last Name:HUDSON
Suffix:JR
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 1:522 WASHINGTON ST APT 201
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4052
Mailing Address - Country:US
Mailing Address - Phone:719-354-3256
Mailing Address - Fax:
Practice Address - Street 1:522 WASHINGTON ST APT 201
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4052
Practice Address - Country:US
Practice Address - Phone:719-354-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date: