Healthcare Provider Details

I. General information

NPI: 1437502069
Provider Name (Legal Business Name): MR. PAUL R HIBBARD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 10TH ST NE
ROME GA
30165-2640
US

IV. Provider business mailing address

409 W 10TH ST NE
ROME GA
30165-2640
US

V. Phone/Fax

Practice location:
  • Phone: 706-406-5092
  • Fax:
Mailing address:
  • Phone: 706-406-5093
  • Fax: 888-807-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: