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NPI Code Detail

MEDICARE: CENTRAL GEORGIA GYNECOLOGY II LLC

MEDICARE: CENTRAL GEORGIA GYNECOLOGY II LLC
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
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1467695882
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL GEORGIA GYNECOLOGY II LLC
Provider Business Mailing Address
First Line : 5909 PEACHTREE DUNWOODY RD NE
Second Line : SUITE 900
City : ATLANTA
State : GA
Zip : 30328-8102
Country : US
Telephone Number : 404-943-0205
Fax Number : 404-943-0209
Provider Business Practice Location Address
First Line : 2410 INGLESIDE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2036
Country : US
Telephone Number : 478-746-1333
Fax Number : 478-738-8638
Authorized Official
Title or Position : BILLING MANAGER
Name : MS. ALICIA HOLDEN
Credential :
Telephone Number : 404-943-0205
Provider Enumeration Date : 04/15/2009
Last Update Date : 04/15/2009

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Directions to “CENTRAL GEORGIA GYNECOLOGY II LLC ” Practice Location

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