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NPI Code Detail

MEDICARE: CANDINCE CHIMERA HODGES

MEDICARE:   CANDINCE CHIMERA HODGES
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
1247200000XOther Technician

General Provider Information

NPI Number : 1407190234
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDINCE CHIMERA HODGES
Provider Business Mailing Address
First Line : 2227 W MAIN ST
Second Line : STE #3
City : JACKSONVILLE
State : AR
Zip : 72076-4207
Country : US
Telephone Number : 501-985-9944
Fax Number : 501-985-6590
Provider Business Practice Location Address
First Line : 2227 W MAIN ST
Second Line : STE #3
City : JACKSONVILLE
State : AR
Zip : 72076-4207
Country : US
Telephone Number : 501-985-9944
Fax Number : 501-985-6590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2012
Last Update Date : 11/16/2012

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Directions to “ CANDINCE CHIMERA HODGES ” Practice Location

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