Provider Demographics
NPI:1548357445
Name:HODGE, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 FREEDOM BLVD
Mailing Address - Street 2:#205
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505
Mailing Address - Country:US
Mailing Address - Phone:843-679-5135
Mailing Address - Fax:843-679-5132
Practice Address - Street 1:1622 CLARENCE COKER HWY
Practice Address - Street 2:
Practice Address - City:TURBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29162
Practice Address - Country:US
Practice Address - Phone:843-659-5070
Practice Address - Fax:843-659-5070
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC048082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC048086Medicaid
SCD176280281Medicare ID - Type Unspecified
SC048086Medicaid