Provider Demographics
NPI:1649851684
Name:HODGE, CAROLINE WELLS (RD)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:WELLS
Last Name:HODGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:M
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:201 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6806
Mailing Address - Country:US
Mailing Address - Phone:334-798-1848
Mailing Address - Fax:
Practice Address - Street 1:148 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1035
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005429133V00000X
AL3172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered