Provider Demographics
NPI:1235229071
Name:O'BRIEN PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:O'BRIEN PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:229-259-9200
Mailing Address - Street 1:1835 NORMAN DR STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-3503
Mailing Address - Country:US
Mailing Address - Phone:229-259-9200
Mailing Address - Fax:
Practice Address - Street 1:1835 NORMAN DR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-3503
Practice Address - Country:US
Practice Address - Phone:229-259-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000617332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment