MEDICARE: DR. JOHN DAVID HODGSON MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	27204	NC
2	207R00000X	Internal Medicine Physician	27204	NC

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

NPI Number	:	1568450682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID HODGSON MD

Provider Business Mailing Address
First Line	:	PO BOX 602530
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2530
Country	:	US
Telephone Number	:	910-642-0331
Fax Number	:	910-642-0597

Provider Business Practice Location Address
First Line	:	619 JEFFERSON ST
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-3707
Country	:	US
Telephone Number	:	910-642-0331
Fax Number	:	910-642-0597

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	12/22/2015

607 JEFFERSON ST
WHITEVILLE, NC
28472-3707

Practice Phone: 910-642-8141
Practice Fax: 910-642-7494