CYNTHIA M THEOBALD (NPI# 1033179700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033179700 |
| Entity Type | Individual |
| Full Name | CYNTHIA M THEOBALD |
| Other Name | CYNTHIA M BOKOR |
| Credential | PA-C |
| Practice Address |
42d Medical Group 300 Twining St., Bldg 760 Maxwell Afb AL 36112 |
| Mailing Address |
1275 Highway 54 W Ste 201 Fayetteville GA 30214-4538 |
| Practice Telephone | 3349533368 |
| Practice Fax Number | 3349538607 |
| Mailing Telephone | 7704613776 |
| Mailing Fax Number | 7704613565 |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2019-04-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 50-002328 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
7814 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1275 Highway 54 W Ste 201, Fayetteville, GA 302144538 | 7704613776 | 7704613565 |
| Street Address |
42D MEDICAL GROUP 300 TWINING ST., BLDG 760 |
| City | MAXWELL AFB |
| State | AL |
| Zip Code | 36112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619516523 | Randi Hughey | Social Worker | 42d Medical Group, 300 S Twining St Bldg 760, Maxwell Afb, AL 36112 | 2019-12-26 |
| 1811313653 | Christine Sirna Bode | Dentist | 42d Medical Group, 300 Twining St Bldg 760, Maxwell Afb, AL 36112 | 2014-03-17 |
| 1215298245 | Ricardo Alejandro Sequeira | Family Medicine | 42d Medical Group, 300 S. Twinning St., Bldg 760, Maxwell Afb, AL 36112 | 2012-06-06 |
| 1659469336 | John Campbell Jr. | Psychologist | 42d Medical Group, 300 Twining Street, Maxwell Afb, AL 36112 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841836970 | Alison Bees Thompson | Social Worker | 42nd Medical Group, 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2019-11-25 |
| 1881245967 | Grant M Golombeski | Military Health Care Provider | 300 S Twinning Dr., Apo, AA 36112 | 2019-09-20 |
| 1477015196 | Jennifer Marie Hudson | Counselor | Jennifer Hudson, 300 South Twining St Bldg 760, Maxwell Afb, AL 36112 | 2019-04-02 |
| 1255801049 | Jose Edwin Aviles | Military Health Care Provider | Kelly Street, Montgomery, AL 36112 | 2018-12-05 |
| 1306316963 | Lydia Price Beringer | Speech-Language Pathologist | 300 S. Twining Street 42 Nd Medical Group, Maxwell Afb, AL 36112 | 2018-11-27 |
| 1114431301 | Dean M Kot | Physician Assistant | Mxf, Kelly St, Apo, AA 36112 | 2017-11-27 |
| 1417353590 | Jamie Ellis | Social Worker | 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2014-11-17 |
| 1629419650 | Elias N Hydrick | Family Medicine | 300 S. Twining St., Bldg 760, Maxwell Afb, 42nd Medical Group, Montgomery, AL 36112 | 2013-07-06 |
| 1639454200 | Sharon Lewis | Pharmacist | 300 Southtwining St, Montgomery, AL 36112 | 2011-10-14 |
| 1104158518 | Sylvia Ann Newell | Dietitian, Registered | 50 W Ash St Bldg 841, Montgomery, AL 36112 | 2010-02-10 |
| Find all providers in zip 36112 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225257629 | John Adam Vann | Physician Assistant | 300 S. Twining Str, Bldg 760, Maxwell Afb, AL 36112 | 2007-04-24 |
| 1497264071 | Nicole Camp | Physician Assistant | 300 Twining St # 760, Maxwell Afb, AL 36112-6027 | 2017-09-26 |
| 1720473754 | Lauren Candee | Physician Assistant | 300 Twining St, #760, Maxwell Afb, AL 36112-6027 | 2015-04-06 |
| 1295961100 | Jason Daniel Hamilton | Physician Assistant | 300 South Twining St, Maxwell Afb, AL 36112 | 2009-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821639154 | Grace Blane Mcmahan | Physician Assistant | 972 Montclair Rd Ste 100, Birmingham, AL 35213-1203 | 2019-10-08 |
| 1013558147 | Advanced Provider Solutions, LLC | Physician Assistant | 245 Cobb Rd, Dothan, AL 36301-7504 | 2019-09-30 |
| 1780247692 | Rachel Anne Stallman | Physician Assistant | 601 S 19th Street, Birmingham, AL 35294-0001 | 2019-04-16 |
| 1679031488 | Katie J Winfrey | Physician Assistant | 1419 Hamric Dr E Ste 101, Oxford, AL 36203-2174 | 2019-03-11 |
| 1235696105 | Audrey Rachel Williamson | Physician Assistant | 2862 Briarfield Ln, Mobile, AL 36693-4068 | 2019-02-26 |
| 1134617996 | Harley Michelle Oliver | Physician Assistant | 820 S. University Blvd Bldg 1, Suite 1b, Mobile, AL 36609 | 2018-04-27 |
| 1952806499 | Christy L Franklin | Physician Assistant | 4305 Dolly Ridge Ln, Vestavia, AL 35243-1834 | 2018-03-27 |
| 1538662994 | Morgan Goss | Physician Assistant | 700 Montgomery Hwy Ste 194, Vestavia Hills, AL 35216-1879 | 2018-03-13 |
| 1770090607 | Gary Andrew Gould | Physician Assistant | 28490 2nd St Ste B, Daphne, AL 36526 | 2017-12-31 |
| 1942748272 | Miranda Hornsby | Physician Assistant | 521 Montgomery Hwy Ste 117, Vestavia, AL 35216-1876 | 2017-02-07 |
| Find all providers with the same taxonomy | ||||
| City | MAXWELL AFB |
| Zip Code | 36112 |
Please comment or provide details below to improve the information on CYNTHIA M THEOBALD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.