Individual
BLAKE M HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 W GREENWOOD ST STE 1, ABBEVILLE, SC 29620-5727
(864) 366-9681
(864) 366-5600
Mailing address
PO BOX 968, ABBEVILLE, SC 29620-0968
(864) 366-5011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35680
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3255
MEDICARE PTAN
SC
05
—
356803
—
SC
01
—
423971
MEDICARE GROUP PTAN
SC
01
—
RHC210
GROUP MEDICAID
SC
Enumeration date
06/14/2013
Last updated
01/06/2023
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