Provider Demographics
NPI:1477657427
Name:BRUCE J SABIN MD PC
Entity Type:Organization
Organization Name:BRUCE J SABIN MD PC
Other - Org Name:BRUCE J SABIN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-979-8022
Mailing Address - Street 1:1790 PRESIDENTIAL CIR
Mailing Address - Street 2:STE C
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1790 PRESIDENTIAL CIR
Practice Address - Street 2:STE C
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5688
Practice Address - Country:US
Practice Address - Phone:770-979-8022
Practice Address - Fax:770-979-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031113332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
1150375OtherOTHER ID NUMBER-COMMERCIAL NUMBER
E19594Medicare ID - Type Unspecified