Individual
BRIAN SHAWN BOBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
882 PONCE DE LEON AVE NE, ATLANTA, GA 30306-4268
(770) 809-3034
(404) 347-9445
Mailing address
3254 KENSINGTON RD, AVONDALE ESTATES, GA 30002-1651
(918) 531-6121
(855) 270-9668
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23821
OK
207Q00000X
Family Medicine Physician
Primary
93772
GA
207Q00000X
Family Medicine Physician
M7864
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F8988
INDIVIDUAL MEDICARE NUMBER
TX
01
—
G36231A
PALMETTO GBA MEDICARE ID
GA
Enumeration date
03/24/2006
Last updated
09/13/2024
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