Provider Demographics
NPI:1437567385
Name:HODGE, ANTHONY QUINN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:QUINN
Last Name:HODGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 JONESBORO RD STE 240
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1035
Mailing Address - Country:US
Mailing Address - Phone:678-855-2242
Mailing Address - Fax:844-272-2789
Practice Address - Street 1:4035 JONESBORO RD STE 240
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1035
Practice Address - Country:US
Practice Address - Phone:679-855-2242
Practice Address - Fax:844-272-2789
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate