Provider Demographics
NPI:1508869538
Name:HODGIN, THOMAS W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:HODGIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:
Practice Address - Street 1:2630 WILLARD DAIRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8351
Practice Address - Country:US
Practice Address - Phone:336-884-3800
Practice Address - Fax:336-884-3801
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126PPMedicaid
NCH21388Medicare UPIN
NC89126PPMedicaid