Provider Demographics
NPI:1215477880
Name:HUBBARD, JAMIE (RT(R)ARRT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RT(R)ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 HWY 21 S
Mailing Address - Street 2:UNIT 4
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5505
Mailing Address - Country:US
Mailing Address - Phone:912-295-5611
Mailing Address - Fax:844-895-6771
Practice Address - Street 1:5906 HWY 21 S
Practice Address - Street 2:UNIT 4
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5505
Practice Address - Country:US
Practice Address - Phone:912-295-5611
Practice Address - Fax:844-895-6771
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA402464247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist