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NPI Code Detail

MEDICARE: MRS. CALLIE GRAY BOBBITT

MEDICARE: MRS. CALLIE GRAY BOBBITT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker4206FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255431938
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CALLIE GRAY BOBBITT
Provider Business Mailing Address
First Line : 1325 GREENDALE AVE UNIT 41
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1084
Country : US
Telephone Number : 850-529-8195
Fax Number :
Provider Business Practice Location Address
First Line : 3686 US HIGHWAY 331 S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-8463
Country : US
Telephone Number : 850-892-8035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 07/08/2007

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