=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457407660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | C JEFFERSON HOOD III PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2007
-----------------------------------------------------
Last Update Date | 02/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 772 MCCURDY AVE S
-----------------------------------------------------
City | RAINSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35986-5211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-279-7505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1508 TATE RD NW
-----------------------------------------------------
City | FORT PAYNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35968-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-357-9568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT 2087
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------