Provider Demographics
NPI:1851465645
Name:HOBBY, MARY GRACE I (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GRACE
Last Name:HOBBY
Suffix:I
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 HOBBY LN
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-1926
Mailing Address - Country:US
Mailing Address - Phone:229-567-2781
Mailing Address - Fax:
Practice Address - Street 1:177 HOBBY LN
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-1926
Practice Address - Country:US
Practice Address - Phone:229-567-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA46478BA1OtherWELLCARE
GA52197809001OtherEDI ENS
GA197996OtherBLUE SHIELD