Provider Demographics
NPI:1346423191
Name:ANNA M. CABECA DO PC
Entity Type:Organization
Organization Name:ANNA M. CABECA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:DONAL
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-267-7780
Mailing Address - Street 1:2712 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4727
Mailing Address - Country:US
Mailing Address - Phone:912-267-7780
Mailing Address - Fax:912-267-6293
Practice Address - Street 1:2712 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4727
Practice Address - Country:US
Practice Address - Phone:912-267-7780
Practice Address - Fax:912-267-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042537207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1659493484Medicaid
GA16BDTRFMedicare PIN