Provider Demographics
NPI:1063440774
Name:NUSSBAUM, DAVID M (D O)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:712 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3271
Mailing Address - Country:US
Mailing Address - Phone:229-276-0052
Mailing Address - Fax:229-276-0064
Practice Address - Street 1:303 FRASER DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-877-2227
Practice Address - Fax:912-877-2332
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB39192207Q00000X
GA067697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1101612OtherMULTIPLAN
GA202I089675OtherMEDICARE
NJ156774OtherONE HEALTH
NJ29640OtherMAGNACARE
NJ33077OtherMASTER CARE
NJ411384MOtherCIGNA
GA003122740AMedicaid
NJ498642OtherAETNA
NJ22-2462363OtherHORIZON
NJ0076492001OtherAMERIHEALTH
NJP902249OtherOXFORD
NJ1042505Medicaid
NJ22-2462363POOOtherPRIVATE HEALTHCARE SYSTEM
NJ31D0111105OtherCLIA
NJ479643OtherUNITED HEALTHCARE
NJF10654OtherHEALTH NET
NJ29640OtherMAGNACARE
NJ33077OtherMASTER CARE