Provider Demographics
NPI:1184853053
Name:OBI, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:OBI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11 JOHN MADDOX DR NW
Mailing Address - Street 2:ROME GI
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1413
Mailing Address - Country:US
Mailing Address - Phone:706-295-3992
Mailing Address - Fax:706-378-5582
Practice Address - Street 1:11 JOHN MADDOX DR NW
Practice Address - Street 2:ROME GI
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1413
Practice Address - Country:US
Practice Address - Phone:706-295-3992
Practice Address - Fax:706-378-5582
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2016-03-15
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Provider Licenses
StateLicense IDTaxonomies
GA075436207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology