Provider Demographics
NPI:1851954440
Name:OGORK, EBOB BESONG (MD)
Entity type:Individual
Prefix:
First Name:EBOB
Middle Name:BESONG
Last Name:OGORK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BESONG
Other - Middle Name:EBOB
Other - Last Name:OGORK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1199 PRINCE AVE # 70
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 NEWNAN CROSSING BLVD E STE 200
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2409
Practice Address - Country:US
Practice Address - Phone:770-400-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA91663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program