Sam Davis Hudnall Jr., PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA6024 Issued in MS

Practice address

4908 Great River Dr
Meridian, MS 39305-2663

Phone

(601) 453-3632

Fax

(601) 453-3633

NPI assigned

Jul 10, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Drayer Physical Therapy Mississippi LLC

  • Physical Therapist
  • Louisville, MS
  • NPI 1952732448
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562716800000",
    "number": "1629620737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 N BROOKMOORE DR",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052024",
            "telephone_number": "662-327-6705",
            "fax_number": "662-327-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4908 GREAT RIVER DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052663",
            "telephone_number": "601-453-3632",
            "fax_number": "601-453-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDNALL",
        "first_name": "SAM",
        "middle_name": "DAVIS",
        "name_suffix": "Jr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-10",
        "last_updated": "2019-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": "PTA6024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hospice Advantage, LLC.
• Hospitalist Services of Meridian PA
• James W Hover, DDS
• Mary Ann Howell, ANP-BC
• Melanie Rae Howse, FNP-C
• Heather Alisha Hudnell, MS, LPC
• Jennifer C Hughes, OTR/L
• Mary Hughes
• Ralph Condon Hughes III, M.D.
• Trenton J Hughes, APRN

• All providers in Meridian, MS
• Physical Therapy Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.