Individual
MICHAEL O'BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3708 CHINABERRY LN, SNELLVILLE, GA 30039-4053
(678) 768-4096
Mailing address
3708 CHINABERRY LN, SNELLVILLE, GA 30039-4053
(678) 768-4096
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
175T00000X
GA
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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