Individual
MR. JEFFREY PAUL HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
1883 HIGHWAY 43 S, SUITE C, CANTON, MS 39046-8405
(601) 859-2906
Mailing address
1883 HIGHWAY 43 S, SUITE C, CANTON, MS 39046-8405
(601) 859-2906
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2160
MS
2255A2300X
Athletic Trainer
AT0161
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01009819
—
MS
01
—
302I658838
MEDICARE PTAN ID#
MS
01
—
512I650001
MEDICARE PTAN
MS
Enumeration date
07/05/2006
Last updated
08/03/2012
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