Healthcare Provider Details

I. General information

NPI: 1144595455
Provider Name (Legal Business Name): ANTHONY CHARLES HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 S I 10 SERVICE RD W FL 2
METAIRIE LA
70001-1234
US

IV. Provider business mailing address

1813 AUBURN AVE
METAIRIE LA
70003-3631
US

V. Phone/Fax

Practice location:
  • Phone: 504-883-3703
  • Fax: 504-833-3704
Mailing address:
  • Phone: 504-813-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number207837
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: