Provider Demographics
NPI:1780675041
Name:HUBBARD, TIMOTHY TERRELL (CSA, CST)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:TERRELL
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:CSA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:321 KIRKLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2023
Mailing Address - Country:US
Mailing Address - Phone:404-993-5096
Mailing Address - Fax:678-442-1158
Practice Address - Street 1:321 KIRKLAND DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2023
Practice Address - Country:US
Practice Address - Phone:404-993-5096
Practice Address - Fax:678-442-1158
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2663363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical