Provider Demographics
NPI:1427274968
Name:VINCENT N. ZUBOWICZ, M.D., P.C.
Entity type:Organization
Organization Name:VINCENT N. ZUBOWICZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:CAMP
Authorized Official - Last Name:BENNEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-814-1100
Mailing Address - Street 1:365 E PACES FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2351
Mailing Address - Country:US
Mailing Address - Phone:404-814-1100
Mailing Address - Fax:404-814-0015
Practice Address - Street 1:365 E PACES FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2351
Practice Address - Country:US
Practice Address - Phone:404-814-1100
Practice Address - Fax:404-814-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00266659CMedicaid
GA00266659CMedicaid