Healthcare Provider Details

I. General information

NPI: 1801273669
Provider Name (Legal Business Name): TAZLEY ANN HOBBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAZLEY ANN HOTZ

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOGWOOD AVE VA BLDG 52
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

BUILDING 69 DOGWOOD AVE
MOUNTAIN HOME TN
37684
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-2225
  • Fax: 423-439-2250
Mailing address:
  • Phone: 423-926-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number58731
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: