Provider Demographics
NPI:1821198557
Name:SABOM, MICHAEL B (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:SABOM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 WEAVER ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3136
Mailing Address - Country:US
Mailing Address - Phone:706-835-1914
Mailing Address - Fax:706-835-1920
Practice Address - Street 1:77 WEAVER ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3136
Practice Address - Country:US
Practice Address - Phone:706-835-1914
Practice Address - Fax:706-835-1920
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2011-09-29
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Provider Licenses
StateLicense IDTaxonomies
GA022632207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000275217FIJHMedicaid
GA202I069515Medicare PIN
GAD30679Medicare UPIN