1154369403 NPI number — DR. RODNEY HAROLD HOBBS JR. MD

Table of content: DALLIN T ERICKSON DO (NPI 1164927133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154369403 NPI number — DR. RODNEY HAROLD HOBBS JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOBBS
Provider First Name:
RODNEY
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154369403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 TROUPE STREET
Provider Second Line Business Mailing Address:
PO BOX 3845
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30914-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-737-4275
Provider Business Mailing Address Fax Number:
706-731-5289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 TOWNE CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
EVANS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30809-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-868-3940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  052582 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: 052582 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: 052582 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 052582 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 28022 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: 052582 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01065845 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 416137 . This is a "WELLCARE OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 553431417B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52222532 . This is a "BCBS GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 553431417G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417O , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154369403 . This is a "BCBS GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 553431417C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280225 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 553431417H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00458485 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 553431417A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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