Provider Demographics
NPI:1629029848
Name:JAMELA HODGSON
Entity Type:Organization
Organization Name:JAMELA HODGSON
Other - Org Name:A SPECIAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMELA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:336-574-0100
Mailing Address - Street 1:500C STATE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5659
Mailing Address - Country:US
Mailing Address - Phone:336-574-0100
Mailing Address - Fax:336-274-2003
Practice Address - Street 1:3606 N ELM ST STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2603
Practice Address - Country:US
Practice Address - Phone:336-708-0915
Practice Address - Fax:336-274-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5333610001Medicare ID - Type Unspecified