Provider Demographics
NPI:1609921865
Name:HODGE, SUSAN FAY (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FAY
Last Name:HODGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 BLACKWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-5329
Mailing Address - Country:US
Mailing Address - Phone:865-228-3663
Mailing Address - Fax:865-828-3594
Practice Address - Street 1:185 JUSTICE CENTER DR.
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861
Practice Address - Country:US
Practice Address - Phone:865-828-5247
Practice Address - Fax:865-828-3594
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000084284163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health