Provider Demographics
NPI:1972069102
Name:HODGE, BRIANNA LASHA
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:LASHA
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-7417
Mailing Address - Country:US
Mailing Address - Phone:256-283-6011
Mailing Address - Fax:
Practice Address - Street 1:1902 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-6615
Practice Address - Country:US
Practice Address - Phone:334-758-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner