Healthcare Provider Details

I. General information

NPI: 1104825710
Provider Name (Legal Business Name): CARL D ATKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 PROSPECT AVE
HUDSON NY
12534-2907
US

IV. Provider business mailing address

69 PROSPECT AVE
HUDSON NY
12534-2907
US

V. Phone/Fax

Practice location:
  • Phone: 518-822-8484
  • Fax:
Mailing address:
  • Phone: 518-822-8484
  • Fax: 518-822-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number143253
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number143253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: