Provider Demographics
NPI:1336455823
Name:SAMUEL B COBARRUBIAS MD, PC
Entity Type:Organization
Organization Name:SAMUEL B COBARRUBIAS MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COBARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-487-1654
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-0028
Mailing Address - Country:US
Mailing Address - Phone:912-487-1654
Mailing Address - Fax:
Practice Address - Street 1:180 CARSWELL ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2413
Practice Address - Country:US
Practice Address - Phone:912-487-1654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1002261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care