Provider Demographics
NPI:1134158124
Name:HODGES, ELAINE SHAW (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:SHAW
Last Name:HODGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:S
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:516 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-1768
Mailing Address - Country:US
Mailing Address - Phone:706-752-0865
Mailing Address - Fax:706-752-0806
Practice Address - Street 1:1550 EATONTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4627
Practice Address - Country:US
Practice Address - Phone:706-752-0322
Practice Address - Fax:978-327-7921
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000377968NMedicaid
GA942882OtherBLUE CROSS
GAP00225806OtherRAILROAD MEDICARE
GAP00225806OtherRAILROAD MEDICARE
GA000377968NMedicaid