Provider Demographics
NPI:1881069037
Name:FOBAS, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FOBAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1332
Mailing Address - Country:US
Mailing Address - Phone:770-393-0855
Mailing Address - Fax:770-393-0856
Practice Address - Street 1:2358 PERIMETER PARK DR
Practice Address - Street 2:SUITE 370
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1332
Practice Address - Country:US
Practice Address - Phone:770-393-0855
Practice Address - Fax:770-393-0856
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies