Provider Demographics
NPI:1194827592
Name:ACOBA, RESORA P (MD)
Entity Type:Individual
Prefix:DR
First Name:RESORA
Middle Name:P
Last Name:ACOBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1378
Mailing Address - Street 2:SW - PATIENT BILLING
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1378
Mailing Address - Country:US
Mailing Address - Phone:229-227-2977
Mailing Address - Fax:229-227-2955
Practice Address - Street 1:400 S PINETREE BLVD.
Practice Address - Street 2:PATIENT BILLING DEPT
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-2977
Practice Address - Fax:229-227-2955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000044208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF12948Medicare UPIN
GA01BDFDMMedicare ID - Type UnspecifiedMEDICARE