Healthcare Provider Details

I. General information

NPI: 1508833351
Provider Name (Legal Business Name): EARNEST COLE HUDSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761B MIDDLE ST
FAIRHOPE AL
36532-1715
US

IV. Provider business mailing address

761B MIDDLE ST
FAIRHOPE AL
36532-1715
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-4750
  • Fax: 251-829-4047
Mailing address:
  • Phone: 251-928-4750
  • Fax: 251-829-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1415
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO308
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: