Provider Demographics
NPI:1689616963
Name:TOMUS, SABIN ALEXANDRU (MD)
Entity type:Individual
Prefix:
First Name:SABIN
Middle Name:ALEXANDRU
Last Name:TOMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:STE 203
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4353
Mailing Address - Country:US
Mailing Address - Phone:912-876-3552
Mailing Address - Fax:912-876-3557
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:STE 203
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4353
Practice Address - Country:US
Practice Address - Phone:912-876-3552
Practice Address - Fax:912-876-3557
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000804669AMedicaid
GA349834OtherWELLCARE
GA10065472OtherAMERIGROUP
GA110216792OtherRR MEDICARE
GA10065472OtherAMERIGROUP
G75793Medicare UPIN