Provider Demographics
NPI:1992323224
Name:HODGES, ALLIX (PA)
Entity type:Individual
Prefix:
First Name:ALLIX
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862-7711
Mailing Address - Country:US
Mailing Address - Phone:607-692-3600
Mailing Address - Fax:
Practice Address - Street 1:2660 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITNEY POINT
Practice Address - State:NY
Practice Address - Zip Code:13862-7711
Practice Address - Country:US
Practice Address - Phone:607-692-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant