Individual
JENNIE L. HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-2542
(706) 721-6676
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2650
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001865
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0148PA
—
SC
05
—
100002064A
—
GA
Enumeration date
09/25/2006
Last updated
04/01/2011
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