Basic Information
| Provider Information | |||||||||
| NPI: | 1831144260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGE | ||||||||
| FirstName: | JUVONDA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40480 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366400480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514705842 | ||||||||
| FaxNumber: | 2514705809 | ||||||||
| Practice Location | |||||||||
| Address1: | 2451 FILLINGIM ST | ||||||||
| Address2: | MASTIN 101 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366172238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514458282 | ||||||||
| FaxNumber: | 2514458281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 24700 | AL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 17-00211 | 01 | AL | UNITED HEALTH CARE | OTHER | 51537957 | 01 | AL | BCBS - 1720 CENTER ST | OTHER | 264984500 | 05 | FL | MEDICAID | 020053576 | 01 | GA | RAILROAD MEDICARE PTAN | OTHER | 51510674 | 01 | AL | BLUE CROSS | OTHER | 51510858 | 01 | AL | BLUE CROSS | OTHER | 00126030 | 05 | MS | MEDICAID | 009994070 | 05 | AL | MEDICAID | 009994110 | 05 | AL | MEDICAID |