Provider Demographics
NPI:1497628242
Name:HODGES, CHARLES III (RN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:HODGES
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:GOROKA
Mailing Address - State:EHP
Mailing Address - Zip Code:00441
Mailing Address - Country:PG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1079
Practice Address - Street 2:
Practice Address - City:GOROKA
Practice Address - State:EHP
Practice Address - Zip Code:00441
Practice Address - Country:PG
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1700914163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice