Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT8022 | GA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT8022 | GA |
NPI | 1104889328 |
---|---|
Provider Name | Mrs. Caron Hobson |
First Address | Powder Springs, GA 30127-4321 |
Second Address | Powder Springs, GA 30127-4321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 06/01/2016 |