Individual
DAVID A THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
610 19TH ST, COLUMBUS, GA 31901-1528
(706) 322-7884
(706) 243-4356
Mailing address
PO BOX 9247, COLUMBUS, GA 31908-9247
(706) 322-7884
(706) 243-4356
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
151127
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136829C
—
GA
Enumeration date
06/20/2013
Last updated
05/06/2015
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