Provider Demographics
NPI:1548727431
Name:HANCOCK, BOBBI ANNE (MS)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:ANNE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:ANNE
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:113 N PATTERSON ST APT B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-5575
Mailing Address - Country:US
Mailing Address - Phone:229-253-1243
Mailing Address - Fax:229-253-1243
Practice Address - Street 1:1341 W HILL AVE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5235
Practice Address - Country:US
Practice Address - Phone:229-253-1243
Practice Address - Fax:229-253-1243
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor