Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 10606 | GA |
NPI | 1366450371 |
---|---|
Provider Name | Dr. Thomas E Osborne |
First Address | Atlanta, GA 30345-2844 |
Second Address | Atlanta, GA 30345-2844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 03/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T97765 | (02) |