Provider Demographics
NPI:1700946043
Name:HODGE, KASINDA LEE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KASINDA
Middle Name:LEE
Last Name:HODGE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 RIDGE BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6896
Mailing Address - Country:US
Mailing Address - Phone:704-408-8915
Mailing Address - Fax:
Practice Address - Street 1:125 DECATUR STREET SE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30302-2905
Practice Address - Country:US
Practice Address - Phone:404-651-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer