Provider Demographics
NPI:1437148657
Name:D'SOUZA, OSBORNE (MD)
Entity Type:Individual
Prefix:DR
First Name:OSBORNE
Middle Name:
Last Name:D'SOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 BUCKHEAD XING
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4257
Mailing Address - Country:US
Mailing Address - Phone:678-324-7406
Mailing Address - Fax:770-627-4322
Practice Address - Street 1:1198 BUCKHEAD XING
Practice Address - Street 2:SUITE C
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4257
Practice Address - Country:US
Practice Address - Phone:678-324-7406
Practice Address - Fax:770-627-4322
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine