Provider Demographics
NPI:1942563770
Name:KUBASOVA, NATALIYA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:KUBASOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-1258
Mailing Address - Country:US
Mailing Address - Phone:706-468-0988
Mailing Address - Fax:706-468-6631
Practice Address - Street 1:898 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1258
Practice Address - Country:US
Practice Address - Phone:706-468-0988
Practice Address - Fax:706-468-6631
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11016443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine