Individual
DR. RANDALL FREDERICK O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2003 ALICE ST, SUITE A, WAYCROSS, GA 31501-6209
(912) 287-1130
(912) 287-9114
Mailing address
PO BOX 2267, WAYCROSS, GA 31502-2267
(912) 283-9309
(912) 287-1231
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
43249
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00764772C
—
GA
01
—
200040070
PALMETTO GBA
GA
Enumeration date
09/27/2005
Last updated
03/25/2010
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