Provider Demographics
NPI:1326099110
Name:HOBBS, MARY B (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:HOBBS
Suffix:
Gender:F
Credentials:MD
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 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-7034
Mailing Address - Fax:864-225-0837
Practice Address - Street 1:705 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5705
Practice Address - Country:US
Practice Address - Phone:864-512-7034
Practice Address - Fax:864-225-0837
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT80560Medicaid
306947105OtherCHAMPUS HEALTHCARE
0568693OtherHEALTHSOURCE