Provider Demographics
NPI:1811994403
Name:HUBBUCH, SEBASTIAN O (MD)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:O
Last Name:HUBBUCH
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:PO BOX 9265
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9265
Mailing Address - Country:US
Mailing Address - Phone:706-565-7382
Mailing Address - Fax:706-565-9110
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 1003
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6877
Practice Address - Country:US
Practice Address - Phone:706-565-7382
Practice Address - Fax:706-565-9110
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-12-23
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
GA23990207RC0000X
GA023990207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL142202Medicaid
GA000390684JMedicaid
GA202I069449Medicare PIN
AL142202Medicaid