Healthcare Provider Details

I. General information

NPI: 1104889328
Provider Name (Legal Business Name): CARON HOBSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5183 MARSDEN TRCE
POWDER SPRINGS GA
30127-4321
US

IV. Provider business mailing address

5183 MARSDEN TRCE
POWDER SPRINGS GA
30127-4321
US

V. Phone/Fax

Practice location:
  • Phone: 404-787-2100
  • Fax: 770-428-7712
Mailing address:
  • Phone: 404-787-2100
  • Fax: 770-428-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8022
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT8022
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: