Provider Demographics
NPI:1093773509
Name:TABLAN, OFELIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:OFELIA
Middle Name:C
Last Name:TABLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 PLEASANT HILL ROAD NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:678-786-1118
Mailing Address - Fax:770-558-1324
Practice Address - Street 1:470 PLEASANT HILL RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2734
Practice Address - Country:US
Practice Address - Phone:678-786-1118
Practice Address - Fax:770-558-1324
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDKWXMedicare ID - Type Unspecified
GAE96880Medicare UPIN