MEDICARE: DR. HOSAMANE S PRABHAKARA 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	208000000X	Pediatrics Physician	042394	GA
2	207K00000X	Allergy & Immunology Physician	042394	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851364749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOSAMANE S PRABHAKARA MD

Provider Business Mailing Address
First Line	:	756 PENINSULA OVERLOOK
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6062
Country	:	US
Telephone Number	:	229-869-0756
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 EAST HOSPITAL ROAD
Second Line	:	EISHENHOWER MEDICAL CTR
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-9123
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	04/23/2024

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