Provider Demographics
NPI:1063507424
Name:HODGES, FRED BARRY III (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:BARRY
Last Name:HODGES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:STE C-220
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3314
Mailing Address - Country:US
Mailing Address - Phone:423-267-4585
Mailing Address - Fax:423-265-4098
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE C-220
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3314
Practice Address - Country:US
Practice Address - Phone:423-267-4585
Practice Address - Fax:423-265-4098
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013754207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3337666Medicaid
TN3337666Medicare ID - Type Unspecified
TN3337666Medicaid
TN1004130001Medicare NSC