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General NPI Number Information
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NPI Number | 1700946043
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Entity Type | Individual
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Provider Name | KASINDA LEE HODGE ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 125 DECATUR STREET SE SECOND FLOOR
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City | ATLANTA
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State | GA
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Zip | 30302-2905
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Country | US
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Telephone | 404-651-3172
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Fax |
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Provider Business Mailing Address
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Address Line | 3721 RIDGE BROOK TRL
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City | DULUTH
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State | GA
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Zip | 30096-6896
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Country | US
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Telephone | 704-408-8915
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1284
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License Number State | NC
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