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General NPI Number Information
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NPI Number | 1144280991
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Entity Type | Individual
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Provider Name | BRIAN SHAWN BOBB M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 882 PONCE DE LEON AVE NE
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City | ATLANTA
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State | GA
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Zip | 30306-4268
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Country | US
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Telephone | 770-809-3034
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Fax | 404-347-9445
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Provider Business Mailing Address
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Address Line | 3254 KENSINGTON RD
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City | AVONDALE ESTATES
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State | GA
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Zip | 30002-1651
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Country | US
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Telephone | 918-531-6121
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Fax | 855-270-9668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23821
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M7864
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 93772
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License Number State | GA
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