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Individual

TERESA B HODGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
575 CLAUD RD, ECLECTIC, AL 36024-6318
(334) 541-3020
(334) 514-3109
Mailing address
PO BOX 241120, ECLECTIC, AL 36024-0018
(334) 541-3020
(334) 541-3109

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004261
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003139656B
GA
05
167905
AL
Enumeration date
09/27/2006
Last updated
02/12/2019
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