Healthcare Provider Details

I. General information

NPI: 1922089176
Provider Name (Legal Business Name): CHARLES F HOBBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N OAK ST BUILDING E
VALDOSTA GA
31602-1744
US

IV. Provider business mailing address

PO BOX 3670
VALDOSTA GA
31604-3670
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-9729
  • Fax: 229-333-0832
Mailing address:
  • Phone: 229-333-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number011957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: