Individual
JODY WADE HUTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12016 N RADIO STATION RD, SENECA, SC 29678-1143
(864) 882-6141
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
828
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08280
—
SC
01
—
828
STATE LICENSE NUMBER
SC
Enumeration date
07/31/2006
Last updated
05/25/2021
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