Provider Demographics
NPI:1417950130
Name:CHEBUHAR, CRAIG M (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:CHEBUHAR
Suffix:
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 1:5505 ROSWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1985
Mailing Address - Country:US
Mailing Address - Phone:404-596-7958
Mailing Address - Fax:404-596-7958
Practice Address - Street 1:5505 ROSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1985
Practice Address - Country:US
Practice Address - Phone:404-596-7958
Practice Address - Fax:404-596-7958
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046946207XS0117X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG08379Medicare UPIN
GA20BBDNXMedicare ID - Type Unspecified