Individual
KENTON DONELLE HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
1940 MOUNTAIN INDUSTRIAL BLVD, TUCKER, GA 30084-6619
(678) 280-0248
Mailing address
7204 BRIGHTON CT, LITHONIA, GA 30058-8239
(229) 400-6457
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1946
GA
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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