Provider Demographics
NPI:1437019825
Name:HODGE, SANDRA MARIE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 STONE MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-1125
Mailing Address - Country:US
Mailing Address - Phone:770-336-7373
Mailing Address - Fax:
Practice Address - Street 1:3035 STONE MOUNTAIN ST
Practice Address - Street 2:PO BOX 1773
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-1125
Practice Address - Country:US
Practice Address - Phone:770-336-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-416970106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician