Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 018479 | GA |
Y | 111NI0900X | Internist | 018479 | GA |
NPI | 1003803347 |
---|---|
Provider Name | Bobb G Cucher |
First Address | Lawrenceville, GA 30043-6611 |
Second Address | Atlanta,, GA 30342-1736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 21/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018479 | LICENSE (01) | GA |
055003709C | (05) | GA |
055003709D | (05) | GA |
055003709E | (05) | GA |
E57173 | (02) | GA |