Provider Demographics
NPI:1215054051
Name:HOBBY, WALLIS (DMD)
Entity type:Individual
Prefix:DR
First Name:WALLIS
Middle Name:
Last Name:HOBBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-2569
Mailing Address - Country:US
Mailing Address - Phone:229-326-4801
Mailing Address - Fax:
Practice Address - Street 1:120 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5209
Practice Address - Country:US
Practice Address - Phone:229-326-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9183415OtherDORAL
GA101078OtherAVESIS
GA852444578AMedicaid