Provider Demographics
NPI:1871583351
Name:HODSON, DARRYL DHAW (MD)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:DHAW
Last Name:HODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2400 BELLEVUE RD
Mailing Address - Street 2:SUITE 21-A
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2885
Mailing Address - Country:US
Mailing Address - Phone:478-275-7202
Mailing Address - Fax:478-274-8418
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4207
Practice Address - Country:US
Practice Address - Phone:478-922-9281
Practice Address - Fax:478-929-6293
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA062723207N00000X, 207ND0101X, 207NP0225X, 207NS0135X, 208D00000X, 207NI0002X, 207ND0900X, 207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA155751983OMedicaid
GA202I07788Medicare PIN
SCAA81249282Medicare PIN