Provider Demographics
NPI:1699903542
Name:LEGACY PEDIATRICS
Entity type:Organization
Organization Name:LEGACY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:CEIDE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-483-2646
Mailing Address - Street 1:556 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4426
Mailing Address - Country:US
Mailing Address - Phone:910-483-2646
Mailing Address - Fax:910-483-9470
Practice Address - Street 1:556 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-483-2646
Practice Address - Fax:910-483-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty