Individual
DR. OSARETIN DANIEL OKUNGBOWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
23 LESTER RD, STATESBORO, GA 30458-4700
(912) 225-1836
(912) 225-0645
Mailing address
23 LESTER RD, STATESBORO, GA 30458-4700
(912) 225-1836
(912) 225-0645
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
62926
GA
207Q00000X
Family Medicine Physician
MD2009-0144
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420313629A
—
GA
Enumeration date
08/29/2007
Last updated
01/20/2012
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