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BOBBY LEE DERRICK MD

>> Emergency Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1124100359

Individual Registrant:
 BOBBY LEE DERRICK MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
117 KITE RD  SWAINSBORO, GA 30401-3231 US
Tel: 478-289-1368  Fax: 478-289-1300

Contact information for business:
PO BOX 879  SWAINSBORO, GA 30401-0879 US
Tel: 478-289-1368  Fax: 478-289-1300

Registration Information:
NPI: 1124100359
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
X207P00000XAllopathic & Osteopathic Physicians
Emergency Medicine
GA019510
X208600000XAllopathic & Osteopathic Physicians
Surgery
GA019510

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS GA - Page 1



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