Provider Demographics
NPI:1033113691
Name:RUBIN, RAYMOND A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:77 BUILDING, 5TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-2905
Mailing Address - Fax:678-244-6608
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:77 BUILDING, 5TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-2905
Practice Address - Fax:678-244-6608
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041204207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00687398Medicaid
GA10BBCDNMedicare ID - Type Unspecified
GA00687398Medicaid