Provider Demographics
NPI:1174279467
Name:HODGES, SAVANAH LEA MICHELLE
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:LEA MICHELLE
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 NINE MILE CRK
Mailing Address - Street 2:
Mailing Address - City:MIDKIFF
Mailing Address - State:WV
Mailing Address - Zip Code:25540-9707
Mailing Address - Country:US
Mailing Address - Phone:681-362-5311
Mailing Address - Fax:
Practice Address - Street 1:767 NINE MILE CRK
Practice Address - Street 2:
Practice Address - City:MIDKIFF
Practice Address - State:WV
Practice Address - Zip Code:25540-9707
Practice Address - Country:US
Practice Address - Phone:681-362-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant