Provider Demographics
NPI:1548576549
Name:HODGE, KATHERINE J (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:J
Last Name:HODGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:J
Other - Last Name:CASSITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-433-6625
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:301 MED TECH PKWY STE 240
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2641
Practice Address - Country:US
Practice Address - Phone:423-794-5520
Practice Address - Fax:423-282-6940
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58-003548207R00000X
VA0102203947207R00000X
TN2704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548576549Medicaid
KY7100307000Medicaid
TNQ006172Medicaid
NC1548576549Medicaid
OHH235751Medicare PIN
NC1548576549Medicaid
VA1548576549Medicaid
VAVVF154AMedicare PIN
TN103I116097Medicare PIN