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General NPI Number Information
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NPI Number | 1861091266
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Entity Type | Individual
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Provider Name | JONATHAN RYAN HUDSON
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Gender | Male
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 329 AULT RD STE B
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377-3126
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Country | US
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Telephone | 423-822-8432
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377-0093
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Country | US
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Telephone | 423-521-5404
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Fax | 706-406-2922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN242148
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0000027716
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License Number State | TN
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