Provider Demographics
NPI:1740227180
Name:SEBASTIAN O. HUBBUCH III M.D.
Entity Type:Organization
Organization Name:SEBASTIAN O. HUBBUCH III M.D.
Other - Org Name:CHATTAHOOCHEE VALLEY CARDIOLOGY M.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HUBBUCH
Authorized Official - Suffix:III
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:2006-06-02
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00390684FMedicaid
GA1811994403OtherNPI
AL5229902570Medicaid
AL009934586Medicaid
AL1477752863Medicaid
GA1841297728OtherNPI
GA353912753AMedicaid
GA721581511AMedicaid
AL009911240Medicaid
1477752863OtherNPI
AL5229902570Medicaid
GA721581511AMedicaid
GA1811994403OtherNPI
GA353912753AMedicaid
GAS73797Medicare UPIN
AL051557344HOLMedicare ID - Type UnspecifiedMEDICARE
GAGRP3846Medicare ID - Type UnspecifiedGA MEDICARE GROUP NUMBER
AL009911240Medicaid