Provider Demographics
NPI:1508090366
Name:OSBORNE, TIMOTHY JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JUSTIN
Last Name:OSBORNE
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 1:619 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-1900
Mailing Address - Country:US
Mailing Address - Phone:205-934-4794
Mailing Address - Fax:
Practice Address - Street 1:303 HARRIS INDUSTRIAL BLVD STE 5
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8854
Practice Address - Country:US
Practice Address - Phone:912-535-7000
Practice Address - Fax:912-535-7020
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8325558207P00000X
GA68085207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine