Healthcare Provider Details

I. General information

NPI: 1992941694
Provider Name (Legal Business Name): JOHANNA MAE HOBBS CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 11/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E GARNETTSVILLE RD
MULDRAUGH KY
40155-1137
US

IV. Provider business mailing address

101 E GARNETTSVILLE RD
MULDRAUGH KY
40155-1137
US

V. Phone/Fax

Practice location:
  • Phone: 502-938-8691
  • Fax:
Mailing address:
  • Phone: 502-938-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: