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General NPI Number Information
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NPI Number | 1063507424
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Entity Type | Individual
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Provider Name | FRED BARRY HODGES III MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1200 MEMORIAL DR
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City | DALTON
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State | GA
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Zip | 30720-2529
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Country | US
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Telephone | 706-272-6596
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Fax | 706-272-6270
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Provider Business Mailing Address
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Address Line | 1200 MEMORIAL DR
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City | DALTON
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State | GA
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Zip | 30720-2529
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Country | US
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Telephone | 706-272-6596
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Fax | 706-272-6270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13754
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 013754
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License Number State | GA
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