Provider Demographics
NPI:1164589750
Name:HODNICK, KERRI (RN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:HODNICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 LAUREL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4844
Mailing Address - Country:US
Mailing Address - Phone:706-589-4511
Mailing Address - Fax:706-869-9669
Practice Address - Street 1:774 LAUREL SPRINGS CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4844
Practice Address - Country:US
Practice Address - Phone:706-589-4511
Practice Address - Fax:706-869-9669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator