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General NPI Number Information
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NPI Number | 1538141031
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Entity Type | Individual
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Provider Name | DOUGLAS B BOBER MD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 5665 PEACHTREE DUNWOODY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1764
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Country | US
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Telephone | 404-778-5712
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Fax | 404-778-3238
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Provider Business Mailing Address
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Address Line | 603 COUNTRYSIDE PL SE
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City | SMYRNA
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State | GA
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Zip | 30080-8238
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Country | US
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Telephone | 869-919-0204
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 67536
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License Number State | GA
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