Healthcare Provider Details

I. General information

NPI: 1902590144
Provider Name (Legal Business Name): KRISTI M HODGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 TORTOISE ST
SUMMERVILLE SC
29483-8989
US

IV. Provider business mailing address

106 TORTOISE ST
SUMMERVILLE SC
29483-8989
US

V. Phone/Fax

Practice location:
  • Phone: 828-231-7849
  • Fax:
Mailing address:
  • Phone: 828-231-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number138414
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number42459
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: