Healthcare Provider Details

I. General information

NPI: 1720080088
Provider Name (Legal Business Name): TIMOTHY E O'BOYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

IV. Provider business mailing address

1111 PROFESSIONAL BLVD
DALTON GA
30720-2588
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-2020
  • Fax: 706-217-2876
Mailing address:
  • Phone: 706-226-2020
  • Fax: 706-217-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number032795
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: