Healthcare Provider Details

I. General information

NPI: 1841651759
Provider Name (Legal Business Name): INNA CUBARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2016
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 JESSE JEWELL PKWY NE STE 102
GAINESVILLE GA
30501-3806
US

IV. Provider business mailing address

743 SPRING ST NE
GAINESVILLE GA
30501-3899
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9445
  • Fax: 770-219-9446
Mailing address:
  • Phone: 770-219-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: