Provider Demographics
NPI:1073656732
Name:CUBIN, ANGELA WARD (CSA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:WARD
Last Name:CUBIN
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0301
Mailing Address - Country:US
Mailing Address - Phone:470-514-5538
Mailing Address - Fax:470-514-5561
Practice Address - Street 1:1265 HIGHWAY 54 W STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4537
Practice Address - Country:US
Practice Address - Phone:470-514-5538
Practice Address - Fax:470-514-5561
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
GA2915246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA863812372OtherN/A