Healthcare Provider Details

I. General information

NPI: 1629029848
Provider Name (Legal Business Name): JAMELA HODGSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 N ELM ST STE F
GREENSBORO NC
27455-2603
US

IV. Provider business mailing address

500C STATE ST
GREENSBORO NC
27405-5659
US

V. Phone/Fax

Practice location:
  • Phone: 336-708-0915
  • Fax: 336-274-2003
Mailing address:
  • Phone: 336-574-0100
  • Fax: 336-274-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMELA ANNETTE HODGSON
Title or Position: OWNER
Credential: CFM
Phone: 336-574-0100