Provider Demographics
NPI:1891752804
Name:TAUBE, TITUS A (MD)
Entity Type:Individual
Prefix:
First Name:TITUS
Middle Name:A
Last Name:TAUBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9006
Mailing Address - Country:US
Mailing Address - Phone:478-953-1800
Mailing Address - Fax:478-953-1931
Practice Address - Street 1:200 S HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3906
Practice Address - Country:US
Practice Address - Phone:478-953-1800
Practice Address - Fax:478-953-1931
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00264371BMedicaid
GA08BBWJBMedicare PIN
C30979Medicare UPIN