=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689631434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE FRANK DOBO MEDICAL DOCTOR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 12/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5041 DALLAS HWY STE D
-----------------------------------------------------
City | POWDER SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-427-5467
-----------------------------------------------------
Fax | 770-427-6340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 MARBLE MILL RD NW
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30060-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-422-1013
-----------------------------------------------------
Fax | 770-514-5996
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 047734
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------