MEDICARE: GEORGIA MATERNAL FETAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	24614	GA

General Provider Information

NPI Number	:	1336439850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA MATERNAL FETAL MEDICINE

Provider Business Mailing Address
First Line	:	990 HAMMOND DR STE 120
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5510
Country	:	US
Telephone Number	:	404-478-3017
Fax Number	:	404-478-3018

Provider Business Practice Location Address
First Line	:	990 HAMMOND DR STE 120
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5510
Country	:	US
Telephone Number	:	404-478-3017
Fax Number	:	404-478-3018

Authorized Official
Title or Position	:	OWNER
Name	:	DR. C ANNE PATTERSON
Credential	:	M.D.
Telephone Number	:	404-478-3017

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	04/04/2016

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