MEDICARE: DR. DOUGLAS B BOBER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	67536	GA

General Provider Information

NPI Number	:	1538141031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS B BOBER MD

Provider Business Mailing Address
First Line	:	603 COUNTRYSIDE PL SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8238
Country	:	US
Telephone Number	:	869-919-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 PEACHTREE DUNWOODY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1764
Country	:	US
Telephone Number	:	404-778-5712
Fax Number	:	404-778-3238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	04/15/2022

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