Provider Demographics
NPI:1346407061
Name:WAYNE HODGES MD
Entity Type:Organization
Organization Name:WAYNE HODGES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-897-6832
Mailing Address - Street 1:100 BLUE FIN CIR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2462
Mailing Address - Country:US
Mailing Address - Phone:912-897-6832
Mailing Address - Fax:
Practice Address - Street 1:100 BLUE FIN CIR
Practice Address - Street 2:SUITE 7
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2462
Practice Address - Country:US
Practice Address - Phone:912-897-6832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000068791GMedicaid
GA08BBQNMMedicare PIN
GAC68895Medicare PIN