Healthcare Provider Details

I. General information

NPI: 1689673048
Provider Name (Legal Business Name): JAMES W HOBACK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CITICO AVE
CHATTANOOGA TN
37404-1127
US

IV. Provider business mailing address

2501 CITICO AVE
CHATTANOOGA TN
37404-1127
US

V. Phone/Fax

Practice location:
  • Phone: 423-697-2000
  • Fax: 423-697-2118
Mailing address:
  • Phone: 423-697-2000
  • Fax: 423-697-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12598
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number12598
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: