Healthcare Provider Details

I. General information

NPI: 1932189917
Provider Name (Legal Business Name): JEFFREY CLAYTON HUDSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

1150 INDIAN CREST DR
INDIAN SPRINGS AL
35124-3008
US

V. Phone/Fax

Practice location:
  • Phone: 205-783-3144
  • Fax: 205-783-3195
Mailing address:
  • Phone: 205-444-1356
  • Fax: 334-396-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1053701
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: