MEDICARE: ATHENA HUBBARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1932518545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA HUBBARD

Provider Business Mailing Address
First Line	:	8474 GARRYOWEN ST
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-7030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8474 GARRYOWEN ST
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-7030
Country	:	US
Telephone Number	:	706-596-5519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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