Individual
MR. JOHN NICHOLAS HODGE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
121 CARROLL ST, SHREVEPORT, LA 71105
(318) 560-4326
Mailing address
121 CARROLL ST, SHREVEPORT, LA 71105-4203
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2106291
TX
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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