Healthcare Provider Details

I. General information

NPI: 1679498497
Provider Name (Legal Business Name): NAGA NAVEEN BOBBALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S 8TH ST STE B
GRIFFIN GA
30224-4884
US

IV. Provider business mailing address

747 S 8TH ST STE B
GRIFFIN GA
30224-4884
US

V. Phone/Fax

Practice location:
  • Phone: 470-604-8250
  • Fax: 770-999-2814
Mailing address:
  • Phone: 470-604-8250
  • Fax: 770-999-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number114040
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: