Basic Information
| Provider Information | |||||||||
| NPI: | 1467421073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOBSON | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 WOOTEN LAKE RD NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301441350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704242020 | ||||||||
| FaxNumber: | 7704248242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 WOOTEN LAKE RD NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301441350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704242020 | ||||||||
| FaxNumber: | 7704248242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 02/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT000797 | GA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000230392B | 05 | GA | MEDICAID |