Healthcare Provider Details

I. General information

NPI: 1124005442
Provider Name (Legal Business Name): NEAL K OSBORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 HOSPITAL DR SUITE 101
DOUGLASVILLE GA
30134-2267
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1600
ATLANTA GA
30308-2208
US

V. Phone/Fax

Practice location:
  • Phone: 678-784-5020
  • Fax: 678-784-5024
Mailing address:
  • Phone: 404-881-1094
  • Fax: 404-874-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45081
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number058553
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: