Provider Demographics
NPI:1417171307
Name:HUBERT, HAROLD DOUGLAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DOUGLAS
Last Name:HUBERT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GREENE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2385
Mailing Address - Country:US
Mailing Address - Phone:706-722-6900
Mailing Address - Fax:706-722-5118
Practice Address - Street 1:701 GREENE ST STE 200
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2385
Practice Address - Country:US
Practice Address - Phone:706-722-6900
Practice Address - Fax:706-722-5118
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063355207RN0300X, 207RN0300X
SCLL31177207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA464300070EMedicaid
GA464300070KMedicaid
GA464300070OMedicaid
GA464300070SMedicaid
GA464300070BMedicaid
GA464300070JMedicaid
GA464300070YMedicaid
GA464300070CMedicaid
GA464300070FMedicaid
GA464300070GMedicaid
GA464300070VMedicaid
GA464300070ZMedicaid
GA464300070AMedicaid
GA464300070DMedicaid
GA464300070MMedicaid
GA464300070UMedicaid
GA464300070HMedicaid
GA464300070NMedicaid
GA464300070WMedicaid
SC1417171307Medicaid
GA464300070IMedicaid
GA464300070RMedicaid
GA464300070LMedicaid
GA464300070PMedicaid
GA464300070QMedicaid
GA464300070TMedicaid
GA464300070XMedicaid