Provider Demographics
NPI:1457451064
Name:HODGES, ERNEST SIDNEY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:SIDNEY
Last Name:HODGES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:855-540-4722
Practice Address - Street 1:160 KIMEL FOREST DR STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6084
Practice Address - Country:US
Practice Address - Phone:336-714-6400
Practice Address - Fax:336-714-6471
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101035208VP0000X, 363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMH0179514OtherDEA
NCMH0179514OtherDEA
NCP89836Medicare UPIN