Healthcare Provider Details

I. General information

NPI: 1316417728
Provider Name (Legal Business Name): MR. PAUL HUTSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5163 CLEVELAND ST
VIRGINIA BEACH VA
23462-6501
US

IV. Provider business mailing address

3027 RACINE AVE
NORFOLK VA
23509-1136
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-4703
  • Fax:
Mailing address:
  • Phone: 757-918-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: