Healthcare Provider Details

I. General information

NPI: 1013055599
Provider Name (Legal Business Name): REBECCA HODGES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 ALBERTA DR
WINONA MS
38967-1538
US

IV. Provider business mailing address

PO BOX 329
KILMICHAEL MS
39747-0329
US

V. Phone/Fax

Practice location:
  • Phone: 662-283-3655
  • Fax:
Mailing address:
  • Phone: 662-262-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08355
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: