Provider Demographics
NPI:1649237207
Name:FRANCO, FABIAN R (MD)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:R
Last Name:FRANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4687
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4687
Mailing Address - Country:US
Mailing Address - Phone:478-328-9690
Mailing Address - Fax:478-328-9692
Practice Address - Street 1:1743 WATSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3633
Practice Address - Country:US
Practice Address - Phone:478-328-9690
Practice Address - Fax:478-328-9692
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047430207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HO8254Medicare UPIN
GA11SCDGPMedicare ID - Type Unspecified