Provider Demographics
NPI:1265620314
Name:CARL R. ZOOBERG MDPC
Entity type:Organization
Organization Name:CARL R. ZOOBERG MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZOOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-856-6983
Mailing Address - Street 1:125 W GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-1848
Mailing Address - Country:US
Mailing Address - Phone:706-856-6983
Mailing Address - Fax:
Practice Address - Street 1:125 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1848
Practice Address - Country:US
Practice Address - Phone:706-856-6983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055361207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA965077042AMedicaid