Provider Demographics
NPI:1942233705
Name:HODGES, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLUE FIN CIR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2462
Mailing Address - Country:US
Mailing Address - Phone:912-897-6832
Mailing Address - Fax:912-897-7151
Practice Address - Street 1:100 BLUE FIN CIR
Practice Address - Street 2:SUITE 7
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2462
Practice Address - Country:US
Practice Address - Phone:912-897-6832
Practice Address - Fax:912-897-7151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029887207Q00000X
SC13647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC68895Medicare UPIN
GA08BBQNMMedicare ID - Type Unspecified