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NPI Code Detail

MEDICARE: BRIAN SHAWN BOBB M.D.

MEDICARE: BRIAN SHAWN BOBB M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician23821OK
2207Q00000XFamily Medicine PhysicianM7864TX
3207Q00000XFamily Medicine Physician93772GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18F8988OTHERTXINDIVIDUAL MEDICARE NUMBER
2G36231AOTHERGAPALMETTO GBA MEDICARE ID

General Provider Information

NPI Number : 1144280991
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN SHAWN BOBB M.D.
Provider Business Mailing Address
First Line : 3254 KENSINGTON RD
Second Line :
City : AVONDALE ESTATES
State : GA
Zip : 30002-1651
Country : US
Telephone Number : 918-531-6121
Fax Number : 855-270-9668
Provider Business Practice Location Address
First Line : 882 PONCE DE LEON AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4268
Country : US
Telephone Number : 770-809-3034
Fax Number : 404-347-9445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 09/13/2024

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Directions to “ BRIAN SHAWN BOBB M.D.” Practice Location

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