Provider Demographics
NPI:1578239448
Name:HOBBY, DEMERE RAE
Entity Type:Individual
Prefix:
First Name:DEMERE
Middle Name:RAE
Last Name:HOBBY
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 1:106 ANDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1601
Mailing Address - Country:US
Mailing Address - Phone:912-571-0809
Mailing Address - Fax:
Practice Address - Street 1:106 ANDERSON WAY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1601
Practice Address - Country:US
Practice Address - Phone:912-342-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-180817106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician