Provider Demographics
NPI:1811415904
Name:HODGES, ALICE (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 BROOKHAVEN CIR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3190
Mailing Address - Country:US
Mailing Address - Phone:404-210-4848
Mailing Address - Fax:
Practice Address - Street 1:1000 LENOX PARK BLVD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-5827
Practice Address - Country:US
Practice Address - Phone:404-261-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA006981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist