MEDICARE: OBOSA OSAWE MD

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
1	207V00000X	Obstetrics & Gynecology Physician	078811	GA
2	207V00000X	Obstetrics & Gynecology Physician	C3186	KY
3	207V00000X	Obstetrics & Gynecology Physician	93507	SC
4	207V00000X	Obstetrics & Gynecology Physician	35C.001862	OH
5	207V00000X	Obstetrics & Gynecology Physician	V2915	TX
6	207V00000X	Obstetrics & Gynecology Physician	257661	NY

General Provider Information

NPI Number	:	1831308675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBOSA OSAWE MD

Provider Business Mailing Address
First Line	:	15 PERRY ST STE 506
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30263-1918
Country	:	US
Telephone Number	:	646-831-7149
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 GREYSTONE POWER BLVD STE 100
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-8297
Country	:	US
Telephone Number	:	678-945-8345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	04/16/2025

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Directions to “ OBOSA OSAWE MD” Practice Location

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