Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 029225 | GA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 029225 | GA |
NPI | 1407843568 |
---|---|
Provider Name | Dr. Keith D. Osborn |
First Address | Cumming, GA 30041-6075 |
Second Address | Cumming, GA 30041-6075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 20/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000339061A | (05) | GA |
B74538 | (02) | GA |