1063440774 NPI number — DR. DAVID M. NUSSBAUM D. O.

Table of content: HELENA YU MD (NPI 1871791665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063440774 NPI number — DR. DAVID M. NUSSBAUM D. O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUSSBAUM
Provider First Name:
DAVID
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D. O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063440774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 N 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDELE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31015-3271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-276-0052
Provider Business Mailing Address Fax Number:
229-276-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 FRASER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-877-2227
Provider Business Practice Location Address Fax Number:
912-877-2332
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MB39192 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 067697 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1101612 . This is a "MULTIPLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 202I089675 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 156774 . This is a "ONE HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 29640 . This is a "MAGNACARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 33077 . This is a "MASTER CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 411384M . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 003122740A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 498642 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2462363 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0076492001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P902249 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1042505 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-2462363POO . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 31D0111105 . This is a "CLIA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 479643 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: F10654 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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