Provider Demographics
NPI:1811665243
Name:HODGES, CHEM
Entity type:Individual
Prefix:
First Name:CHEM
Middle Name:
Last Name:HODGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 STABLE PARK CT
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6193
Mailing Address - Country:US
Mailing Address - Phone:901-549-3655
Mailing Address - Fax:
Practice Address - Street 1:1594 STABLE PARK CT
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-6193
Practice Address - Country:US
Practice Address - Phone:901-549-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN121121441172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver