Provider Demographics
NPI:1639146293
Name:OSEHOBO, EHI PHILIP (MD PHD)
Entity Type:Individual
Prefix:
First Name:EHI
Middle Name:PHILIP
Last Name:OSEHOBO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230B WEST COLLEGE ST
Mailing Address - Street 2:STE B
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4121
Mailing Address - Country:US
Mailing Address - Phone:678-688-1155
Mailing Address - Fax:678-688-5071
Practice Address - Street 1:230 WEST COLLEGE ST
Practice Address - Street 2:STE B
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4121
Practice Address - Country:US
Practice Address - Phone:678-688-1155
Practice Address - Fax:678-688-5071
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA187778601AMedicaid
GA187778601AMedicaid
H33567Medicare UPIN