Healthcare Provider Details

I. General information

NPI: 1689811390
Provider Name (Legal Business Name): SEBASTIAN O. HUBBUCH M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 GENTIAN BLVD
COLUMBUS GA
31907-1147
US

IV. Provider business mailing address

PO BOX 8709
COLUMBUS GA
31908-8709
US

V. Phone/Fax

Practice location:
  • Phone: 706-565-7382
  • Fax: 706-565-9110
Mailing address:
  • Phone: 706-565-7382
  • Fax: 706-565-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16161
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number532
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number242
License Number StateAL

VIII. Authorized Official

Name: DR. SEBASTIAN OTTO HUBBUCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-565-7382