Healthcare Provider Details

I. General information

NPI: 1982106456
Provider Name (Legal Business Name): HUDSON AMC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 IRVING PLACE
SHREVEPORT LA
71101
US

IV. Provider business mailing address

PO BOX 1684
SHREVEPORT LA
71165-1684
US

V. Phone/Fax

Practice location:
  • Phone: 318-425-4096
  • Fax:
Mailing address:
  • Phone: 318-424-4008
  • Fax: 855-230-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MITCHELL HUDSON JR.
Title or Position: MEMBER
Credential: MD
Phone: 601-310-7466