Provider Demographics
NPI:1124005442
Name:OSBORN, NEAL K (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:K
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:404-874-1249
Practice Address - Street 1:8855 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2267
Practice Address - Country:US
Practice Address - Phone:678-784-5020
Practice Address - Fax:678-784-5024
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN45081207R00000X
GA058553207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN966425400Medicaid
MN110008502Medicare ID - Type Unspecified
H33088Medicare UPIN
MN966425400Medicaid