Healthcare Provider Details

I. General information

NPI: 1063458842
Provider Name (Legal Business Name): OLIVER JAY HODGKISS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 E CUTLAR XING
LELAND NC
28451-6484
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 919-332-3800
  • Fax: 910-251-0421
Mailing address:
  • Phone: 910-332-3800
  • Fax: 910-251-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: