Provider Demographics
NPI:1427016351
Name:HUBRICH, LEON RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:RAYMOND
Last Name:HUBRICH
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 1:1000 HAWTHORNE AVE
Mailing Address - Street 2:SUITE S
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-548-1386
Mailing Address - Fax:706-369-1903
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:SUITE S
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-548-1386
Practice Address - Fax:706-369-1903
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017693207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40198Medicare UPIN