Healthcare Provider Details

I. General information

NPI: 1013945930
Provider Name (Legal Business Name): JOHN RICHARD HODGES JR. M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SAINT SEBASTIAN WAY SUITE5B
AUGUSTA GA
30901-2643
US

IV. Provider business mailing address

393 N BELAIR RD
EVANS GA
30809-3096
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-2400
  • Fax: 706-724-9211
Mailing address:
  • Phone: 706-868-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36175
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: