Provider Demographics
NPI:1316016298
Name:PABIA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:PABIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 LANDAU DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2121
Mailing Address - Country:US
Mailing Address - Phone:334-487-7472
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTHERN WAY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9204
Practice Address - Country:US
Practice Address - Phone:706-324-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005108OtherLICENSE#