Basic Information
| Provider Information | |||||||||
| NPI: | 1528166972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABE | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | BRADFORD | ||||||||
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| OtherLastName: | CABE | ||||||||
| OtherFirstName: | GEORGE | ||||||||
| OtherMiddleName: | BRADFORD | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 407 | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304750407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125374986 | ||||||||
| FaxNumber: | 9125388166 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 J L WHITE DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301434894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066923539 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 64194 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 204938 | MA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 131271 | 01 | MA | HARVARD PILGRIM | OTHER | J22792 | 01 | MA | BLUE CROSS & BLUE SHIELD | OTHER | 0123731 | 05 | MA | MEDICAID |