Provider Demographics
NPI:1942639307
Name:RUBIN, POLINA (PA-C)
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1280
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4792
Mailing Address - Country:US
Mailing Address - Phone:404-257-1589
Mailing Address - Fax:404-303-1950
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1280
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4792
Practice Address - Country:US
Practice Address - Phone:404-257-1589
Practice Address - Fax:404-303-1950
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9109212363A00000X
GA10368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant