Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 36175 | GA |
NPI | 1013945930 |
---|---|
Provider Name | Dr. John Richard Hodges JR. |
First Address | Evans, GA 30809-3096 |
Second Address | Augusta, GA 30901-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 25/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00532144A | (05) | GA |
F52528 | (02) | GA |