Healthcare Provider Details

I. General information

NPI: 1356022859
Provider Name (Legal Business Name): TAWANA HUBBARD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAWANA HUBBARD WILLIAMS

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LE PHILLIP CT NE
CONCORD NC
28025-2900
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax: 706-842-5340
Mailing address:
  • Phone: 706-842-5330
  • Fax: 706-842-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-544449
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: