Basic Information
Provider Information
NPI: 1003803347
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUCHER
FirstName: BOBB
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X018479GAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
01847901GALICENSEOTHER
055003709E05GA MEDICAID
055003709D05GA MEDICAID
055003709C05GA MEDICAID


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