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General NPI Number Information
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NPI Number | 1942305156
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Entity Type | Individual
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Provider Name | SUSAN M. HODGE P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 602 KNOX ST
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City | BARBOURVILLE
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State | KY
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Zip | 40906-1304
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Country | US
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Telephone | 606-546-6027
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Fax | 606-546-2084
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Provider Business Mailing Address
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Address Line | 602 KNOX ST
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City | BARBOURVILLE
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State | KY
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Zip | 40906-1304
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Country | US
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Telephone | 606-546-6027
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Fax | 606-546-2084
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA896
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA896
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License Number State | KY
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