Provider Demographics
NPI:1639191612
Name:O'BANNON, ROBERT T III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:O'BANNON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:80 NEWNAN STATION DR
Mailing Address - Street 2:STE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3194
Mailing Address - Country:US
Mailing Address - Phone:770-814-6011
Mailing Address - Fax:770-814-6011
Practice Address - Street 1:13040 ABERCORN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1955
Practice Address - Country:US
Practice Address - Phone:770-645-9181
Practice Address - Fax:770-645-8455
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-08-10
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Provider Licenses
StateLicense IDTaxonomies
WV22326207L00000X
GA060309207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA433679505BMedicaid
GA511I050303Medicare PIN