Provider Demographics
NPI:1376904094
Name:HODGES, CHELSEA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
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 1:209 GREEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5251
Mailing Address - Country:US
Mailing Address - Phone:615-830-2031
Mailing Address - Fax:
Practice Address - Street 1:263 SEABOARD LN
Practice Address - Street 2:SUITE 200
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4877
Practice Address - Country:US
Practice Address - Phone:615-591-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001555174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist