Provider Demographics
NPI:1154403582
Name:RUBIN, MITZI B (MD)
Entity type:Individual
Prefix:DR
First Name:MITZI
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 WHITCHER ST NE STE 400
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1129
Mailing Address - Country:US
Mailing Address - Phone:470-956-3960
Mailing Address - Fax:770-590-3710
Practice Address - Street 1:55 WHITCHER ST NE STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1129
Practice Address - Country:US
Practice Address - Phone:470-956-3960
Practice Address - Fax:770-590-3710
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA49592207QB0002X
GA049592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH57222Medicare UPIN
GA08BBWMBMedicare PIN