Provider Demographics
NPI:1871991398
Name:PAUL W. HUTCHISON, D.P.M.
Entity type:Organization
Organization Name:PAUL W. HUTCHISON, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-365-3668
Mailing Address - Street 1:105-D MUELLER BRASS ROAD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019
Mailing Address - Country:US
Mailing Address - Phone:901-476-0404
Mailing Address - Fax:901-476-0465
Practice Address - Street 1:105-D MUELLER BRASS ROAD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019
Practice Address - Country:US
Practice Address - Phone:901-476-0404
Practice Address - Fax:901-476-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN475213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531380Medicaid
TN4008710002Medicare NSC
TN3352246Medicare PIN
TN1531380Medicaid