Healthcare Provider Details

I. General information

NPI: 1023194073
Provider Name (Legal Business Name): NORMAN EDWARD HOBBS SURGEON'S ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD STE 603
MONTGOMERY AL
36116-2014
US

IV. Provider business mailing address

301 BROWN SPRINGS RD
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-8800
  • Fax: 334-747-8810
Mailing address:
  • Phone: 334-747-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-111
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: