Provider Demographics
NPI:1801987441
Name:DUBIN, STEVIN A (MD)
Entity type:Individual
Prefix:DR
First Name:STEVIN
Middle Name:A
Last Name:DUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3468 STALLINGS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9544
Mailing Address - Country:US
Mailing Address - Phone:706-267-9685
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:ROOM2144
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028535207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000324717BMedicaid
SCG28535Medicaid
GA550789920OtherTRICARE
GA339271OtherWELLCARE CMO
GA048046OtherBCBS
GA050018185OtherRRMEDICARE
GA000324717CMedicaid
GA339271OtherWELLCARE CMO
GA000324717BMedicaid