Provider Demographics
NPI:1598301657
Name:HUBBARD, DAVID LEWIS (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEWIS
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73709
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-3709
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:
Practice Address - Street 1:10800 MIDLOTHIAN TPKE STE 265
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4700
Practice Address - Country:US
Practice Address - Phone:804-594-1383
Practice Address - Fax:804-594-0915
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR106754367500000X
GARN293987367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered