Provider Demographics
NPI:1689811390
Name:SEBASTIAN O. HUBBUCH M.D.
Entity Type:Organization
Organization Name:SEBASTIAN O. HUBBUCH M.D.
Other - Org Name:CHATTAHOOCHEE VALLEY CARDIOLOGY MD, P.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:HUBBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-565-7382
Mailing Address - Street 1:PO BOX 8709
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8709
Mailing Address - Country:US
Mailing Address - Phone:706-565-7382
Mailing Address - Fax:706-565-9110
Practice Address - Street 1:3808 GENTIAN BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-1147
Practice Address - Country:US
Practice Address - Phone:706-565-7382
Practice Address - Fax:706-565-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16161207RC0000X
AL532363AM0700X
AL242363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9911240Medicaid
AL9934586Medicaid
AL1477752863Medicaid
AL9911240Medicaid
AL9934586Medicaid
AL05155734Medicare PIN