Healthcare Provider Details

I. General information

NPI: 1174569941
Provider Name (Legal Business Name): JASON HOBBS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CORDER RD SUITE 100
WARNER ROBINS GA
31088-3702
US

IV. Provider business mailing address

300 MARGIE DR
WARNER ROBINS GA
31088-7817
US

V. Phone/Fax

Practice location:
  • Phone: 478-322-1113
  • Fax: 478-322-1114
Mailing address:
  • Phone: 478-751-2580
  • Fax: 478-953-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: