Healthcare Provider Details

I. General information

NPI: 1801457064
Provider Name (Legal Business Name): GARY HODGE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 JEFFERSON STREET, SUITE 350
LAUREL MS
39440
US

IV. Provider business mailing address

300 GREENO RD S
FAIRHOPE AL
36532-1905
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-5990
  • Fax: 601-425-7510
Mailing address:
  • Phone: 251-929-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number37133
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number41796
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: