Provider Demographics
NPI:1659493484
Name:CABECA, ANNA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:CABECA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30062
Mailing Address - Street 2:
Mailing Address - City:SEA ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31561-0062
Mailing Address - Country:US
Mailing Address - Phone:904-452-8433
Mailing Address - Fax:404-348-0200
Practice Address - Street 1:133 CENTER ST
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1590
Practice Address - Country:US
Practice Address - Phone:904-452-8432
Practice Address - Fax:404-348-0200
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042537207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000835997BMedicaid
GA000835997BMedicaid