Provider Demographics
NPI:1982935623
Name:HODGES, PAM G
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:G
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 219
Mailing Address - Street 2:
Mailing Address - City:PLANTERSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38862-9775
Mailing Address - Country:US
Mailing Address - Phone:662-842-4877
Mailing Address - Fax:662-842-4330
Practice Address - Street 1:2464 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PLANTERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38862-9775
Practice Address - Country:US
Practice Address - Phone:662-842-4877
Practice Address - Fax:662-842-4330
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR597775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily