Provider Demographics
NPI:1174055263
Name:BASHUK, CAROL ROOBIN (MED)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ROOBIN
Last Name:BASHUK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 INGLESIDE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2096
Mailing Address - Country:US
Mailing Address - Phone:478-743-1452
Mailing Address - Fax:478-743-3338
Practice Address - Street 1:634 FIRST STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-743-1452
Practice Address - Fax:478-743-3338
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
GAHADS000136237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter