Healthcare Provider Details

I. General information

NPI: 1467500132
Provider Name (Legal Business Name): T HOFFLER ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 KAY ST POB 98
FOLKSTON GA
31537-3914
US

IV. Provider business mailing address

PO BOX 98 105 KAY ST
FOLKSTON GA
31537-0098
US

V. Phone/Fax

Practice location:
  • Phone: 912-496-3509
  • Fax: 912-496-0850
Mailing address:
  • Phone: 912-496-3509
  • Fax: 912-496-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002961
License Number StateGA

VIII. Authorized Official

Name: MR. JTOBY HOFFLER
Title or Position: CEO
Credential: LCSW
Phone: 912-496-3509