Healthcare Provider Details

I. General information

NPI: 1619332798
Provider Name (Legal Business Name): ANJENEE HOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 S COBB DR SE
MARIETTA GA
30060-3303
US

IV. Provider business mailing address

1033 S COBB DR SE
MARIETTA GA
30060-3303
US

V. Phone/Fax

Practice location:
  • Phone: 770-420-8110
  • Fax:
Mailing address:
  • Phone: 770-420-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number81-0830322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: