Provider Demographics
NPI:1972708774
Name:CZUBOKA, CARL JOSEPH WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH WILLIAM
Last Name:CZUBOKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2400 MOUNT ZION PKWY
Mailing Address - Street 2:INTERNAL MEDICINE B
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2500
Mailing Address - Country:US
Mailing Address - Phone:770-603-3605
Mailing Address - Fax:
Practice Address - Street 1:2400 MOUNT ZION PKWY
Practice Address - Street 2:INTERNAL MEDICINE B
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:770-603-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA058735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine