Healthcare Provider Details

I. General information

NPI: 1013652825
Provider Name (Legal Business Name): MADISON DUVAL HOBBS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

791 WYLIE ST SE APT 914
ATLANTA GA
30316-7206
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2000
  • Fax:
Mailing address:
  • Phone: 925-918-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7097
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11058
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: