Provider Demographics
NPI:1093702540
Name:SUBER, HUBERT MCCRARY (MD)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:MCCRARY
Last Name:SUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUBERT
Other - Middle Name:M
Other - Last Name:SUBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-537-4986
Mailing Address - Fax:912-538-8166
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8852
Practice Address - Country:US
Practice Address - Phone:912-537-1014
Practice Address - Fax:912-538-1538
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000260774CMedicaid
235753OtherBLUE CROSS BLUE SHIELD
GAD30941Medicare UPIN
GA000260774CMedicaid