Brian Shawn Bobb, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

93772 Issued in GA

Practice address

882 Ponce de Leon Ave NE
Atlanta, GA 30306-4268

Phone

(770) 809-3034

Fax

(404) 347-9445

NPI assigned

Mar 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment NPD
• South Austin Family Practice Clinic, PLLC

  • Family Medicine Physician
  • Austin, TX
  • NPI 1235130592
  Medicare reassignment NPD
• Lifelong Wellness Center Inc

  • Family Medicine Physician
  • Tahlequah, OK
  • NPI 1043413487
  NPD (past)
• Memorial Hermann Medical Group

  • Family Medicine Physician
  • Fulshear, TX
  • NPI 1003985102
  NPD (past)
• Washington Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, PA
  • NPI 1639133861
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1144280991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3254 KENSINGTON RD",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021651",
            "telephone_number": "918-531-6121",
            "fax_number": "855-270-9668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "882 PONCE DE LEON AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303064268",
            "telephone_number": "770-809-3034",
            "fax_number": "404-347-9445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 Benney Ln Ste 200",
            "address_purpose": "LOCATION",
            "city": "Dripping Springs",
            "state": "TX",
            "postal_code": "786205559",
            "country_code": "US",
            "telephone_number": "512-858-2997",
            "fax_number": "855-270-9668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBB",
        "first_name": "BRIAN",
        "middle_name": "SHAWN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "23821",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M7864",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "93772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL MEDICARE NUMBER",
            "identifier": "8F8988",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA MEDICARE ID",
            "identifier": "G36231A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Boatner, CNM
• Emyshia Boatwright
• Bob Schumacher, D.C., P.C.
• Kaylin Bob
• Bobb G Cucher MD and Caroline M Abruzese MD LLC
• Bobby Dodd Institute
• Douglas B Bober, MD
• Lauren R Bober, PT
• Hansley Bobo, MD
• Katherine Sonja Bobrek

• Family Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.