Healthcare Provider Details

I. General information

NPI: 1629851779
Provider Name (Legal Business Name): NATASHA HODGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SAINT ANNES DR
HATTIESBURG MS
39401-8252
US

IV. Provider business mailing address

477 FLYNT RD
LAUREL MS
39443-9057
US

V. Phone/Fax

Practice location:
  • Phone: 601-447-4658
  • Fax:
Mailing address:
  • Phone: 601-270-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number241000
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: