Provider Demographics
NPI:1356582019
Name:HODGES, TIFFANY ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANNE
Last Name:HODGES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 OLD 41 HWY NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4420
Mailing Address - Country:US
Mailing Address - Phone:770-428-8686
Mailing Address - Fax:
Practice Address - Street 1:1815 OLD 41 HWY NW
Practice Address - Street 2:SUITE 110
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4420
Practice Address - Country:US
Practice Address - Phone:770-428-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3258103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent