Healthcare Provider Details

I. General information

NPI: 1962002535
Provider Name (Legal Business Name): GINA HOBRECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BOWENS MILL RD SE
DOUGLAS GA
31533-1500
US

IV. Provider business mailing address

1838 NEW FOREST HWY
DOUGLAS GA
31533-6214
US

V. Phone/Fax

Practice location:
  • Phone: 912-384-5492
  • Fax:
Mailing address:
  • Phone: 706-247-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: