Provider Demographics
NPI:1417298035
Name:O'BRIEN PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:O'BRIEN PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:HAS
Authorized Official - Phone:229-259-9200
Mailing Address - Street 1:1310 BAYTREE RD
Mailing Address - Street 2:B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-3058
Mailing Address - Country:US
Mailing Address - Phone:229-259-9200
Mailing Address - Fax:229-259-9003
Practice Address - Street 1:1310 BAYTREE RD
Practice Address - Street 2:B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3058
Practice Address - Country:US
Practice Address - Phone:229-259-9200
Practice Address - Fax:229-259-9003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALDOSTA HEARING AID CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA617332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment