Provider Demographics
NPI:1306401534
Name:HOSKINS, MARY EVELYN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EVELYN
Last Name:HOSKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2A QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4108
Mailing Address - Country:US
Mailing Address - Phone:678-914-1114
Mailing Address - Fax:
Practice Address - Street 1:2A QUAIL RUN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4108
Practice Address - Country:US
Practice Address - Phone:678-914-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor