Basic Information
| Provider Information | |||||||||
| NPI: | 1003803347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUCHER | ||||||||
| FirstName: | BOBB | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1838 AMERICAN WAY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300436611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709957622 | ||||||||
| FaxNumber: | 7709957854 | ||||||||
| Practice Location | |||||||||
| Address1: | 5669 PEACHTREE DUNWOODY RD. NE | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | ATLANTA, | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788436400 | ||||||||
| FaxNumber: | 6788436405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 018479 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 055003709D | 05 | GA | MEDICAID | 055003709E | 05 | GA | MEDICAID | 055003709C | 05 | GA | MEDICAID | 018479 | 01 | GA | LICENSE | OTHER |