MEDICARE: MS. KASINDA LEE HODGE ATC, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1284	NC

General Provider Information

NPI Number	:	1700946043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KASINDA LEE HODGE ATC, LAT

Provider Business Mailing Address
First Line	:	3721 RIDGE BROOK TRL
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-6896
Country	:	US
Telephone Number	:	704-408-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 DECATUR STREET SE
Second Line	:	SECOND FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30302-2905
Country	:	US
Telephone Number	:	404-651-3172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2006
Last Update Date	:	07/08/2007

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