Provider Demographics
NPI:1831144260
Name:HODGE, JUVONDA S (MD)
Entity type:Individual
Prefix:
First Name:JUVONDA
Middle Name:S
Last Name:HODGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-1318
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-1229
Practice Address - Fax:601-815-4570
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24700208600000X
GA71993208600000X
MS32486208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126030Medicaid
AL009994070Medicaid
AL009994110Medicaid
FL264984500Medicaid
AL51510858OtherBLUE CROSS
GA020053576OtherRAILROAD MEDICARE PTAN
AL51537957OtherBCBS - 1720 CENTER ST
AL17-00211OtherUNITED HEALTH CARE
AL51510674OtherBLUE CROSS
AL51537957OtherBCBS - 1720 CENTER ST
GA020053576OtherRAILROAD MEDICARE PTAN