Provider Demographics
NPI:1003803347
Name:CUCHER, BOBB G (MD)
Entity Type:Individual
Prefix:
First Name:BOBB
Middle Name:G
Last Name:CUCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1838 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6611
Mailing Address - Country:US
Mailing Address - Phone:770-995-7622
Mailing Address - Fax:770-995-7854
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD. NE
Practice Address - Street 2:SUITE 390
Practice Address - City:ATLANTA,
Practice Address - State:GA
Practice Address - Zip Code:30342-1736
Practice Address - Country:US
Practice Address - Phone:678-843-6400
Practice Address - Fax:678-843-6405
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA018479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055003709DMedicaid
GA055003709EMedicaid
GA055003709CMedicaid
GA018479OtherLICENSE
GA055003709CMedicaid
GA018479OtherLICENSE
GAE57173Medicare UPIN