Provider Demographics
NPI:1548338619
Name:ELLISON-HODGES, CHANTE MONIQUE (MD)
Entity type:Individual
Prefix:
First Name:CHANTE
Middle Name:MONIQUE
Last Name:ELLISON-HODGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANTE
Other - Middle Name:MONIQUE
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24721 TOMBALL PKWY
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-7727
Mailing Address - Country:US
Mailing Address - Phone:281-290-0786
Mailing Address - Fax:281-290-0863
Practice Address - Street 1:24721 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-7727
Practice Address - Country:US
Practice Address - Phone:281-290-0786
Practice Address - Fax:281-290-0863
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052351207Q00000X
TXQ1595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine