Provider Demographics
NPI:1053620385
Name:HYMAN, BOBBY E SR (CSAC)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:E
Last Name:HYMAN
Suffix:SR
Gender:M
Credentials:CSAC
Other - Prefix:MR
Other - First Name:BOBBY
Other - Middle Name:E
Other - Last Name:HYMAN
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:CSAC 2222
Mailing Address - Street 1:120 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-9501
Mailing Address - Country:US
Mailing Address - Phone:252-402-9906
Mailing Address - Fax:
Practice Address - Street 1:504 GREEN ST E
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4176
Practice Address - Country:US
Practice Address - Phone:252-291-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2222Medicaid