Provider Demographics
NPI:1992965792
Name:O'BANION, DENNIS DAVID JR (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:DAVID
Last Name:O'BANION
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:D DAVID
Other - Middle Name:
Other - Last Name:O'BANION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 TULLIE RD NE FL 4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2309
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-4750
Practice Address - Street 1:1400 TULLIE RD NE FL 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2309
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-4750
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA750842080P0006X
OK285242080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200337720AMedicaid