Healthcare Provider Details

I. General information

NPI: 1376285528
Provider Name (Legal Business Name): DAVID GRAHAM HODGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GRAHAM HODGE MD

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MS-16
JACKSON MS
39051
US

IV. Provider business mailing address

1100 MS-16
CARTHAGE MS
39051
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-1000
  • Fax:
Mailing address:
  • Phone: 601-267-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35671
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35671
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: