MEDICARE: MR. JEFFREY PAUL HODGES PT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT2160	MS
2	2255A2300X	Athletic Trainer	AT0161	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	512I650001	OTHER	MS	MEDICARE PTAN
3	302I658838	OTHER	MS	MEDICARE PTAN ID#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134150816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY PAUL HODGES PT, ATC

Provider Business Mailing Address
First Line	:	1883 HIGHWAY 43 S
Second Line	:	SUITE C
City	:	CANTON
State	:	MS
Zip	:	39046-8405
Country	:	US
Telephone Number	:	601-859-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1883 HIGHWAY 43 S
Second Line	:	SUITE C
City	:	CANTON
State	:	MS
Zip	:	39046-8405
Country	:	US
Telephone Number	:	601-859-2906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/03/2012

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Directions to “ MR. JEFFREY PAUL HODGES PT, ATC” Practice Location

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