Provider Demographics
NPI:1992941694
Name:HOBBS, JOHANNA MAE (CSA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MAE
Last Name:HOBBS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E GARNETTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MULDRAUGH
Mailing Address - State:KY
Mailing Address - Zip Code:40155-1137
Mailing Address - Country:US
Mailing Address - Phone:502-938-8691
Mailing Address - Fax:
Practice Address - Street 1:101 E GARNETTSVILLE RD
Practice Address - Street 2:
Practice Address - City:MULDRAUGH
Practice Address - State:KY
Practice Address - Zip Code:40155-1137
Practice Address - Country:US
Practice Address - Phone:502-938-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA177246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant