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General NPI Number Information
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NPI Number | 1346236155
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Entity Type | Individual
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Provider Name | RANDALL FREDERICK O'BRIEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 2003 ALICE ST SUITE A
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City | WAYCROSS
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State | GA
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Zip | 31501-6209
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Country | US
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Telephone | 912-287-1130
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Fax | 912-287-9114
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Provider Business Mailing Address
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Address Line | PO BOX 2267
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City | WAYCROSS
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State | GA
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Zip | 31502-2267
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Country | US
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Telephone | 912-283-9309
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Fax | 912-287-1231
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 43249
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License Number State | GA
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