1861685877 NPI number — DR. JIMBA T TOBINS MD

Table of content: DR. JIMBA T TOBINS MD (NPI 1861685877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861685877 NPI number — DR. JIMBA T TOBINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOBINS
Provider First Name:
JIMBA
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1861685877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
677 CHURCH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-793-7750
Provider Business Mailing Address Fax Number:
470-986-7142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
677 CHURCH ST NE # 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-793-7750
Provider Business Practice Location Address Fax Number:
770-793-7755
Provider Enumeration Date:
08/22/2007

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: 207R00000X , with the licence number:  059894 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 059894 , 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: 111260768F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111260768E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52230211 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 9749109 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00468642 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111260768H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01157487 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2850783 . This is a "UHC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111260768G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 425575 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111260768B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2173855 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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