Provider Demographics
NPI:1417424060
Name:HODGES, LAURA WOOTTEN (MPH, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:WOOTTEN
Last Name:HODGES
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:WOOTTEN
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RD, LDN
Mailing Address - Street 1:5450 TRICK TALBERT RD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MS
Mailing Address - Zip Code:39320-9735
Mailing Address - Country:US
Mailing Address - Phone:601-527-7646
Mailing Address - Fax:
Practice Address - Street 1:2000 15TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4138
Practice Address - Country:US
Practice Address - Phone:601-553-6284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
MSD1714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist