MEDICARE: OBSTETRIX MEDICAL GROUP OF ATLANTA, 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
1	207VM0101X	Maternal & Fetal Medicine Physician

General Provider Information

NPI Number	:	1609617166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBSTETRIX MEDICAL GROUP OF ATLANTA, LLC

Provider Business Mailing Address
First Line	:	1301 CONCORD TER
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2843
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 VILLAGE CENTER BLVD STE 110
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3589
Country	:	US
Telephone Number	:	843-236-7878
Fax Number	:	855-527-5510

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSANNE HECK
Credential	:
Telephone Number	:	800-243-3839

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	10/23/2024

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