Provider Demographics
NPI:1831308675
Name:OSAWE, OBOSA (MD)
Entity type:Individual
Prefix:
First Name:OBOSA
Middle Name:
Last Name:OSAWE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PERRY ST STE 506
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1918
Mailing Address - Country:US
Mailing Address - Phone:646-831-7149
Mailing Address - Fax:
Practice Address - Street 1:120 GREYSTONE POWER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-8297
Practice Address - Country:US
Practice Address - Phone:678-945-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078811207V00000X
KYC3186207V00000X
SC93507207V00000X
OH35C.001862207V00000X
TXV2915207V00000X
NY257661207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY257661Medicare PIN
NY03261332Medicaid