Provider Demographics
NPI:1083762025
Name:HODGE-SPEARS, KIMBERLY N (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:HODGE-SPEARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 SAVANNAH PL STE 101A-B
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6376
Mailing Address - Country:US
Mailing Address - Phone:770-707-4018
Mailing Address - Fax:770-785-4488
Practice Address - Street 1:3625 SAVANNAH PL STE 101A-B
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6376
Practice Address - Country:US
Practice Address - Phone:770-707-4018
Practice Address - Fax:770-785-4488
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60084208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A721430Medicaid
CA00A721430Medicaid
I28246Medicare UPIN