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BOBBY LEE DERRICK MD
>> Emergency Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1124100359
Individual Registrant: BOBBY LEE DERRICK MD
Gender: M
Not Sole Proprietor
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
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
Tel: 478-289-1368 Fax: 478-289-1300
Registration Information:
NPI: 1124100359
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| X | 207P00000X | Allopathic & Osteopathic Physicians Emergency Medicine | GA | 019510 |
| X | 208600000X | Allopathic & Osteopathic Physicians Surgery | GA | 019510 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
