Provider Demographics
NPI:1891441523
Name:HODGSON, DANIEL HENRY (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HENRY
Last Name:HODGSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 STRAW FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5961
Mailing Address - Country:US
Mailing Address - Phone:865-748-4545
Mailing Address - Fax:
Practice Address - Street 1:1932 ALCOA HWY STE 360
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1509
Practice Address - Country:US
Practice Address - Phone:865-524-1869
Practice Address - Fax:865-544-6533
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4913363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty