Healthcare Provider Details

I. General information

NPI: 1629709100
Provider Name (Legal Business Name): KRISTA RAYNES HOBSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/27/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8399 HIGHWAY 16
SENOIA GA
30276-3139
US

IV. Provider business mailing address

8399 HIGHWAY 16
SENOIA GA
30276-3139
US

V. Phone/Fax

Practice location:
  • Phone: 404-849-7180
  • Fax:
Mailing address:
  • Phone: 404-849-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN183664
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: