Provider Demographics
NPI:1346460870
Name:O'BRIEN, DEREK JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOHNSON
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1772 CENTURY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3396
Mailing Address - Country:US
Mailing Address - Phone:404-248-1159
Mailing Address - Fax:404-248-9776
Practice Address - Street 1:1772 CENTURY BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3396
Practice Address - Country:US
Practice Address - Phone:404-248-1159
Practice Address - Fax:404-248-9776
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0401782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHO6795Medicare UPIN
GA26BDHLLMedicare ID - Type Unspecified