Provider Demographics
NPI:1386319713
Name:HODGE, ADAM S
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:HODGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GLENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2317
Mailing Address - Country:US
Mailing Address - Phone:479-228-3761
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP, UNIT 5268, KADENA AIR BASE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367
Practice Address - Country:US
Practice Address - Phone:315-634-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist